[Show abstract][Hide abstract] ABSTRACT: A 67-year-old woman, who received postoperative chemotherapy, was admitted to the hospital for granulocytopenia and severe pneumonia, sepsis, and DIC. After intensive care, she developed a lung abscess in the right upper lobe. Antibiotics and transbronchial drainage were unsuccessful, she underwent fenestration and cavernostomy open drainage of the right anterior chest. The general status improved, and infection in the cavity was under control, so we performed omental pack through a retrosternal route with sternal elevation bar and closure of fenestration. The patient was discharged with a favorable clinical condition on the 18th postoperative day. We suggest that a retrosternal route through sternal elevation leads to smooth surgery for similar cases.
Preview · Article · Jan 2015 · The Journal of the Japanese Associtation for Chest Surgery
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of a pulmonary vein stump thrombus detected by a contrast-enhanced computed tomography for transient syncope 2 days after upper division segmentectomy of the left lung for metastatic pulmonary tumor. The thrombus disappeared without embolic events after anticoagulation with intravenous heparin followed by oral warfarin. Considering this case and previous reports, thoracic surgeons should be aware of pulmonary vein stump thrombus, a latent source of systemic embolization, after pulmonary resection, especially lobectomy or segmentectomy of the left upper lobe. This possible serious complication can occur at any time from the early postoperative period.
No preview · Article · Mar 2013 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old woman was referred to our hospital presenting high serum levels of calcium (Ca) and intact-parathyroid hormone (PTH) and an anterior mediastinal nodule of 18×13 mm in size on chest computed tomography (CT). Tumor was suspected of a parathyroid tumor. 99mTc-methoxy-isobutylisonitrile( MIBI) scintigram showed abnormal radioactive tracer accumulation in the lesion. 3 ml/kg of methylene blue was administered intravenously an hour before surgery, and the stained tumor was successfully resected by thoracoscopic surgery. Pathological diagnosis was parathyroid hyperplasia. Postoperative course was uneventful and serum levels of Ca and intact-PTH returned to normal ranges.
No preview · Article · Mar 2013 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Several recent studies have demonstrated that some patients might benefit from aggressive therapy for thoracic stage I lung cancer and synchronous solitary brain metastasis. However, the indication for the patients with advanced T-stage is still unclear. We herein present a patient with synchronous solitary brain metastasis from non-small cell lung cancer who survived without recurrence for 5 years following surgery after chemotherapy, even though the primary tumor was T3N0 thoracic stage II. Aggressive treatment for both the primary site and brain metastasis may therefore be an effective treatment for locally advanced non-small cell lung cancer patients with synchronous solitary brain metastasis.
No preview · Article · May 2012 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: Pulmonary adenosquamous carcinoma is a rare malignant tumor as defined by the Japan Lung Cancer Society Classification. At our institution, of the 1,023 patients who underwent resection for primary lung cancer, 42 (4.0%) had adenosquamous carcinoma. Here, we present the clinical features of this malignant tumor. The male : female ratio was low. Many tumors were located peripherally, and the positive rate for carcinoembryonic antigen (CEA) was 54.8%; these clinical findings were similar to those of adenocarcinoma. On the other hand, many tumors had relatively large diameter, and most of the patients were heavy smokers; these findings were consistent with those of squamous cell carcinoma. Hence, the cases of adenosquamous carcinoma had the characteristics of both adenocarcinoma and squamous cell carcinoma. The prognosis of patients with adenosquamous carcinoma was poorer than those of patients with adenocarcinoma and those with squamous cell carcinoma, irrespective of whether it was stages I or II. Adenosquamous carcinoma is characterized by a highly aggressive biological behavior and a high rate of early metastasis. Therefore, even if the diagnosis is made at an early phase, an aggressive approach, including adjuvant chemotherapy, might be necessary for adenosquamous carcinoma.
No preview · Article · Sep 2011 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Staple bullectomy is widely performed for the thoracoscopic treatment of spontaneous pneumothorax. When weak emphysematous
change was observed to extend to the whole pleura around the localized bulla, weak emphysematous pleura always remain around
the stapler after bullectomy. Such cases along with weak pleural surfaces around staplers belong to the groups at high risk
of postoperative recurrence. We performed thoracoscopic ablation using an ultrasonically activated device (USAD) for such
lesions and studied the efficacy. From April 2002 to December 2006, a total of 85 surgeries for spontaneous pneumothorax were
performed in this hospital, of which 34 cases underwent ablation with a USAD for a weak pleural surface. No complications
due to ablation were observed. Recurrence was observed in four subjects, but the cause of recurrence was the regeneration
of a bulla outside the range of the ablation and was unrelated to the ablation itself. Moreover, significant white pleural
thickening was observed at the ablation sites, demonstrating a stiffening effect of the weak visceral pleura. Ablation using
a USAD is a safe and easy operative method, and it is an appropriate operative system as a stiffening procedure for a visceral
Preview · Article · Mar 2011 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Several methods using various materials have so far been reported to repair pulmonary air leaks, which is an essential problem in general thoracic surgery. Although the efficacy of these materials has been often discussed, the safety has only rarely been examined. This study evaluated the safety of polyglycolic acid (PGA) felt, one of the most commonly materials employed at this institute.
A total of 1026 patients who underwent a pulmonary resection from January 2000 to December 2007 were enrolled in this study. The status of PGA use, type of surgery, and incidence and type of surgical site infection (SSI) were reviewed retrospectively from the clinical records.
Three hundred and forty-four patients were treated with PGA. Although two patients in the PGA group underwent a reoperation, PGA itself was not causative. In one case, the PGA felt strictly adhered to both the parietal and visceral pleura.
Polyglycolic acid felt can be used safely in general thoracic surgery and did not influence the incidence or type of SSI. Surgeons should be aware of the possibility of adhesion around the material at the time of re-operation, and the criteria of PGA use should be strictly discussed.
[Show abstract][Hide abstract] ABSTRACT: The candidate tumor suppressor NORE1A is a nucleocytoplasmic shuttling protein, and although a fraction of the NORE1A in cells is localized to their centrosomes, the role of centrosomal NORE1A has not been elucidated. In this study we investigated the role of NORE1A in the numerical integrity of centrosomes and chromosome stability in lung cancer cells. Exposure of p53-deficient H1299 lung cancer cell line to hydroxyurea (HU) resulted in abnormal centrosome amplification (to 3 or more centrosomes per cell) as determined by immunofluorescence analysis with anti-γ-tubulin antibody, and forced expression of wild-type NORE1A partially suppressed the centrosome amplification. The nuclear export signal (NES) mutant (L377A/L384A) of NORE1A did not localize to centrosomes and did not suppress the centrosome amplification induced by HU. Fluorescence in situ hybridization analyses with probes specific for chromosomes 2 and 16 showed that wild-type NORE1A, but not NES-mutant NORE1A, suppressed chromosome instability in HU-exposed H1299 cells that was likely to have resulted from centrosome amplification. We next examined the status of NORE1A mRNA expression in non-small cell lung carcinoma (NSCLC) and detected down-regulation of NORE1A mRNA expression in 25 (49%) of 51 primary NSCLCs by quantitative real-time-polymerase chain reaction analysis. These results suggest that NORE1A has activity that suppresses the centrosome amplification induced by HU and that NORE1A mRNA down-regulation is one of the common gene abnormalities in NSCLCs, both of which imply a key preventive role of NORE1A against the carcinogenesis of NSCLC.
[Show abstract][Hide abstract] ABSTRACT: EML4-ALK fusion transcripts have been found in a subset of non-small cell lung carcinomas (NSCLCs); however, their protein expression status has not yet been fully elucidated. In this study we investigated ALK protein expression in 302 NSCLCs and 291 gastric carcinomas by means of immunohistochemical analysis. Twelve (4.0%) NSCLCs, but none of the gastric carcinomas, were found to be positive for ALK. The ALK signal was detected in the cytoplasm of cancer cells. Subsequent RNA analysis of 10 RNA-available, immunohistochemically ALK-positive tumors revealed that three tumors had EML4-ALK variant 1, three tumors had variant 2, three tumors had variants 3a and 3b, and one tumor had a novel variant in which exon 14 of EML4 is connected to the nucleotide at position 53 of exon 20 of ALK by a 2-bp insertion. These results suggest that immunohistochemical ALK detection is a useful way to screen NSCLCs for tumors containing ALK fusions.
No preview · Article · Feb 2010 · Experimental and therapeutic medicine
[Show abstract][Hide abstract] ABSTRACT: Recent clinical trials have shown significant survival benefits from postoperative adjuvant chemotherapy for resected non-small-cell lung cancer (NSCLC). However, due to the comparatively low compliance in recent clinical trials, this study investigated the feasibility of adjuvant chemotherapy with gemcitabine plus split-dose cisplatin for completely resected NSCLC.
Gemcitabine at a dose of 1000 mg m(-2) and cisplatin at 40 mg m(-2) were given intravenously on days 1 and 8 every 4 weeks for a maximum of four cycles. According to Simon's minimax two-stage design, if the regimen was judged to be safe and tolerable in five or more of the seven patients in the first stage, then enrollment would increase to a total of 20 patients. The feasibility of this regimen was proven if four cycles of chemotherapy were completed in more than 14 patients. The primary endpoint was the compliance to this regimen in the adjuvant setting, while the secondary endpoints were safety and toxicity.
The regimen was judged to be safe and tolerable in the first stage, and therefore 21 patients were accrued as planned. Twenty patients (95%) received four cycles of chemotherapy; therefore chemotherapy compliance in the four cycles was 95%. The relative dose intensity was 97% for both gemcitabine and cisplatin. Grade 3/4 toxicities of neutropenia occurred in 33% and thrombocytopenia in 20%. Nonhematological adverse effects were extremely rare.
Adjuvant chemotherapy with gemcitabine and split-dose cisplatin showed a favorable feasibility and acceptable toxicity in Japanese NSCLC patients.
[Show abstract][Hide abstract] ABSTRACT: Objective. To perform a retrospective analysis of chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC) in order to evaluate treatment efficacy and toxicity. Methods. We performed a retrospective analysis of 24 patients aged 70 years or more with advanced NSCLC who received chemotherapy from June 2003 to December 2006. Results. The median age was 75 years (range, 70-88). Twenty-four patients received a total of 50 cycles of chemotherapy; 76% (38 of 50 cycles) of which chemotherapies were platinum-based doublet regimens. The regimen of almost all combined chemotherapy patients consisted of carboplatin and paclitaxel. The overall response rate was 17% and disease control rate was 79%. The median survival time (MST) was 15.6 months. Although grade 3/4 neutropenia was observed in 58% of the patients, other toxicities were generally mild. Conclusion. Platinum-based doublet was used in 76% of the 24 elderly patients with advanced NSCLC. Although grade 3/4 neutropenia was observed in 58% of the patients, it was controllable. Chemotherapy performed in the present series was found generally safe. The observed 15.6 month MST was acceptable.
[Show abstract][Hide abstract] ABSTRACT: Pleural lavage cytology (PLC) has been reported to be a significant prognostic factor in patients with operable non-small cell lung cancer (NSCLC). PLC may detect micro metastasis in patients without apparent pleural effusion or dissemination. Although many studies have reported PLC as a good predictor of postoperative recurrence, its role in the staging of NSCLC and in determining adjuvant therapy is still controversial. From June 1999 through December 2006, PLC immediately after thoracotomy was performed in 284 NSCLC patients without effusion or dissemination. Cases with exploratory thoracotomy were excluded from this study. Results of PLC were evaluated with other clinicopathological factors, and the difference in survival according to PLC status was investigated. Thirteen patients with positive PLC showed a poorer disease-free survival (P<0.0001) compared to those with negative PLC. The difference in survival rate between patients with positive and negative PLC, was significant in stage I disease, but not in stage II and III disease. PLC is a useful predictive marker for postoperative recurrence and should be routinely evaluated in lung cancer surgery, especially, in stage I disease. PLC might also assist in guiding adjuvant therapy.
Full-text · Article · Mar 2009 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: The incidence of several extracolonic tumors, such as duodenal carcinoma, is higher in familial adenomatous polyposis (FAP) patients than in the general population, but there is little information about lung carcinoma in FAP. A 43-year-old woman presented with a lung tumor 17 years after total colectomy for FAP. Pathohistological analysis of the lung tumor demonstrated mixed adenocarcinoma consisting of a papillary adenocarcinoma component and a bronchioloalveolar carcinoma component. Sequencing analysis indicated a germline APC mutation from TCA to TGA (stop) at codon 1110, but no pathogenic germline MYH mutations. The other APC allele in the lung carcinoma was not inactivated by somatic mutations, promoter methylation, or chromosomal deletion. No somatic mutations in any of the coding regions of the p53 gene or in the mutation hot spot regions of the K-ras or EGFR genes were detected in the carcinoma. Amplification, however, of three chromosome regions, 5p, 8q, and 12q14-12q21, was identified in the carcinoma on genome-wide high-resolution single-nucleotide polymorphism (SNP) microarray. The present results suggest that the chromosomal copy number alterations detected on SNP microarray were involved in the carcinogenesis of the adenocarcinoma of the lung in the present FAP patient.
No preview · Article · Dec 2008 · Pathology International
[Show abstract][Hide abstract] ABSTRACT: There is a CA dinucleotide repeat polymorphism in the first intron of the epidermal growth factor receptor (EGFR) gene. Our aim was to examine the relationship between the CA repeat length in lung carcinoma and EGFR mutation, EGFR gene copy number, and EGFR protein expression level in the carcinoma.
We examined 168 lung carcinomas for the length of the CA repeat polymorphism by PCR-polyacrylamide gel electrophoresis analysis, for EGFR mutations by sequencing analysis, for EGFR gene copy number by fluorescence in situ hybridization analysis, and for EGFR protein expression by immunohistochemical analysis.
When the carcinomas were divided into two groups according to the length of their CA repeat polymorphism, the EGFR protein expression level was found to be significantly higher in the shorter allele group than in the longer allele group (P = 0.0116), but its length was not associated with EGFR somatic mutations, high EGFR gene copy numbers, or clinicopathological factors, such as histological type or stage.
The results suggested that the length of the EGFR CA repeat polymorphism in lung carcinoma is inversely related with level of EGFR protein expression in the carcinoma.
No preview · Article · Nov 2008 · Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: Recent studies have reported increased podoplanin expression by cancer cells and stromal cells, but little is known about its expression and biological significance in adenocarcinoma of the lung. We examined podoplanin expression by both cancer cells and stromal cells in 177 consecutive lung adenocarcinoma cases and analyzed relations between podoplanin expression and both clinicopathological factors and outcome. Podoplanin expression was observed on the apical membrane of the cancer cells in only 9 of the 177 (5.1%) cases. By contrast, cancer-associated fibroblasts (CAFs) were found to express podoplanin in 54 cases (30.5%). Podoplanin (+) CAFs were found only in invasive adenocarcinoma and none were found in noninvasive adenocarcinoma. Conventional prognostic factors were significantly correlated with podoplanin expression by CAFs. The univariate analyses and log-rank test showed that podoplanin expression was significantly associated with shorter survival time (p < 0.001 and p < 0.001, respectively). We divided the cases into 3 groups according grade based on the proportion of CAFs expressing podoplanin [a grade 0 group (n = 123), a grade 1 group (n = 36) and a grade 2 group (n = 18)]. The result showed that conventional prognostic factors were significantly correlated with the grade of podoplanin expression by CAFs. Furthermore, the grade 2 group tended to have a shorter survival time than the grade 1 group (p = 0.092). The results of this study highlight the importance of podoplanin expression by CAFs and provide new insights into the biology of the cancer microenvironment in adenocarcinoma of the lung.
Full-text · Article · Sep 2008 · International Journal of Cancer
[Show abstract][Hide abstract] ABSTRACT: A 51-year-old woman developed heart failure due to severe hypertension of the upper half of the body caused by coarctation of the aorta. From the available surgical options for this condition, we selected bypass grafting from the left subclavian artery to the descending aorta for this patient.
No preview · Article · Aug 2008 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: Pleomorphic carcinoma (PC) of the lung is rare, and it is classified as a subtype of sarcomatoid carcinoma of the lung in the World Health Organization histologic classification of lung tumors. In this study, 70 cases of PC surgically resected were reviewed to identify its clinicopathologic characteristics. There were 57 men and 13 women, and their mean age was 66 years (range: 29 to 80 y). Sixty-eight tumors contained identifiable epithelial components, and the other 2 consisted of spindle cells and giant cells alone. An adenocarcinoma component was found in 34 cases, a squamous cell carcinoma component in 13, and a large cell carcinoma component in 40. The overall survival rate and disease-free survival rate were 36.6% and 40.7%, respectively, and both rates were significantly lower than for other nonsmall cell lung carcinomas. When the PC patients were divided into 3 groups according to the predominant epithelial component, an adenocarcinoma group, squamous cell carcinoma group, and large cell carcinoma group, there were no significant differences in the overall survival rate and median survival time between the 3 groups. Univariate analysis revealed that advanced stage (stage III), mediastinal lymph node metastasis, lymphatic permeation, and histologically diagnosed massive coagulation necrosis (>25% of the tumor) predicted poorer disease-free survival. Multivariate analysis showed that massive necrosis alone was an independent prognostic factor. We concluded that PC should be considered as an aggressive disease and massive necrosis should be routinely reported and used as a factor in clinical assessments.
No preview · Article · Aug 2008 · The American journal of surgical pathology
[Show abstract][Hide abstract] ABSTRACT: Obstruction of blood flow through the arteria radicularis magna (ARM) has been linked with ischemic spinal cord injury after conventional thoracic aortic repair. Whether or not endoluminal stent-grafts, deliberately positioned against this artery can cause similar damage to the spinal cord has not been comprehensively investigated. The purpose of this study was to assess the blood and cerebrospinal fluid (CSF) concentrations of lactate - a well-known biochemical marker of ischemic neurological injury, before and after stent-graft implantation against the ARM.
Endoluminal stent-grafting was performed in ten mongrel dogs. In five animals (experimental group), stent-grafts covered the fourth and fifth lumbar segmental arteries - which have been described as the canine equivalents to the ARM in humans. In the remaining five animals (control group), devices of similar length were placed in the lower thoracic aorta. CSF was obtained by cisternal puncture technique at the following time points; before stent-grafting, and 15, 30 and 60 min after stent-grafting. Parallel arterial blood samples were also obtained using a heparinized syringe. All samples were centrifuged and the supernatant analysed for lactate.
The mean preprocedural lactate concentration in the CSF was 1.7+/-0.3 mmol/l. Mean postprocedural levels in the experimental group at 15, 30 and 60 min were 3.1+/-1.9, 3.9+/-1.1 and 11.9+/-2.5 mmol/l, respectively (control values; 2.1+/-1.9, 2.7+/-1.1 and 1.9+/-1.5 mmol/l, respectively). Mean preprocedural blood lactate level was 1.8+/-0.6 mmol/l, while the mean postprocedural concentrations in the experimental group at 15, 30 and 60 min were 2.9+/-1.2, 3.4+/-1.7 and 3.9+/-2.0 mmol/l, respectively. Two out of the five animals in the experimental group suffered mild to moderate hind limb weakness.
Selective placement of stent-grafts against the ARM in dogs resulted in a conspicuous increase in CSF and blood lactate concentrations 60 min after the procedure with or without physical signs of neurological deficits. Although the small sample size of this preliminary study does not allow any definitive conclusion, it may be worthwhile to confirm the findings in appropriately controlled larger studies.
Preview · Article · May 2008 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: EML4-ALK gene fusions have recently been discovered in a subset of human lung carcinomas, and fusions of the ALK tyrosine kinase gene with the NPM, TPM3, CLTC, ATIC, and TFG genes have been found in hematological malignancies. To elucidate the role of fusions between ALK and other genes in pulmonary carcinogenesis, we examined 77 non-small cell lung carcinomas (NSCLCs) for EML4-, NPM-, TPM3-, CLTC-, ATIC-, and TFG-ALK fusion transcripts by RT-PCR and subsequent sequencing analysis. Although no expression of NPM-, TPM3-, CLTC-, ATIC-, or TFG-ALK fusion transcripts were detected in any of the cases, expression of EML4-ALK fusion transcripts was detected in two (2.6%) of the 77 NSCLCs. In one of the two NSCLCs there was fusion between exon 13 of EML4 and exon 20 of ALK, i.e., variant 1, and in the other there was fusion between exon 20 of EML4 and exon 20 of ALK, i.e., variant 2. Both patients had a history of smoking, and histologically the carcinomas were adenocarcinoma. No somatic mutations were detected in the mutation cluster regions of the EGFR, K-RAS, and PIK3CA genes in these two carcinomas, however, a Pro177Ser mutation of the p53 gene was detected in the carcinoma that contained the variant 1 EML4-ALK fusion transcripts. In situ PCR of a paraffin block section showed that the carcinoma with expression of the variant 1 actually contained an EML4-ALK fusion gene. These results suggested that the EML4-ALK fusion gene product is involved in the carcinogenesis of a subset of NSCLCs.
[Show abstract][Hide abstract] ABSTRACT: An 80-year-old man developed a pseudoaneurysm in the ascending aorta due to mediastinitis following cardiac surgery. We successfully repaired the pseudoaneurysm with an autograft patch harvested from fascia lata and the saphenous vein. The repair, which was carried out in two layers, can be expected to be durable.
No preview · Article · Jan 2008 · General Thoracic and Cardiovascular Surgery