Effect of landiolol hydrochloride, an ultra-short-acting beta 1-selective blocker, on supraventricular tachycardia, atrial fibrillation and flutter after pulmonary resection.

WHAT IS KNOWN AND OBJECTIVE: Supraventricular tachycardia is a common complication after pulmonary resection. The objective of this study was to investigate the efficacy of landiolol hydrochloride, an ultra-short-acting ß1-blocker, in patients with post-operative supraventricular tachycardia after pulmonary resection. METHODS: The response to continuous intravenous infusion of landiolol was evaluated in 25 patients who developed post-operative atrial fibrillation or atrial flutter after major pulmonary resection. Four patients had preoperative rate-controlled chronic atrial fibrillation. The heart rate and blood pressure were compared before and after infusion of landiolol. Side effects and recurrence of supraventricular tachycardia after termination of landiolol infusion were also monitored. RESULTS AND DISCUSSION: The heart rate was reduced from 135±24 bpm before landiolol infusion to a plateau rate of 85±19 bpm during infusion (P<0·0001). Heart rate reduction occurred in all but two patients. Conversion to normal sinus rhythm from supraventricular tachycardia occurred in 14 patients (56%). Recurrence of supraventricular tachycardia after stopping landiolol infusion was observed in 17 patients (68%), but all patients without preoperative AF were cured of post-operative AF. There were no detectable side effects, including no adverse influence on the circulatory and respiratory systems. WHAT IS NEW AND CONCLUSION: Continuous intravenous infusion of landiolol was found to be effective and safe for supraventricular tachycardia after pulmonary resection.

[Surgical treatment for secondary pneumothorax in elderly patients].

Surgical treatment for secondary pneumothorax in elderly patients is very difficult because of having a high perioperative risk related to the presence of underlying chronic lung disease. In this study, we performed a retrospective review of elderly (> or = 70 years old) 35 patients with secondary pneumothorax who underwent surgical treatment between 2000 and 2009. Of the 35 patients, 31 were men and 4 were women with an average age 77.9 years old. Seventeen patients of them had already received oxygen therapy. They were not only in chronic respiratory failure but also malnutrition. Hospital mortality rate was 14.3%. Three patients died within 30 postoperative days and 2 patients were with hospital death after operation. The 5-year survival rate in patients with secondary pneumothorax was 41.7%. Although secondary pneumothorax is one of benign pulmonary diseases, its prognosis in elderly patients is poor. In conclusion, prompt diagnosis and treatment of secondary pneumothorax in elderly patients are mandatory. They could improve the outcome of this disease.

[Surgical approach to primary lung cancer using video-assisted thoracic surgery].

Video-assisted thoracic surgery (VATS) is now commonly used to treat malignant tumors of the lung. Generally, there are 2 styles of VATS: one uses only the view in a monitor and the other makes use of direct vision through an access port. Since both are minimally invasive, the difference is a matter of the surgeon's preference, and it is likely to have no effect on the patient. In all cases, we seek to minimize the destruction and deformation of the thoracic wall while maintaining the quality of the surgical procedure. We consider VATS to be a standard procedure. Many studies have compared the results of VATS and thoracotomy, but it is unlikely that thoracotomy will suddenly replace VATS. Usually, the standard surgical procedure changes gradually. If the surgeon encounters unexpected circumstances, he or she could change the surgical approach. We think that the border between thoracoscopic surgery and thoracotomy is blurred. Between 1998 and 2008, we operated on 395 patients with primary lung cancer. Of these, 207 cases with stage I underwent a lobectomy with lymph node dissection. There were no differences in survival, according to surgical approach. Although we have not always adopted VATS for advanced lung cancer, we are using a similar approach to perform any kind of bronchoplasty, pneumonectomy, or extensive resection for lung cancer more effectively. It is a step forward to be able to perform surgery using advanced techniques but, ultimately, it is not the technique that is of primary importance, it is the benefit the patient receives.

[Surgical resection of T3 and T4 lung cancer].

Lung cancer invading neighboring anatomical structures such as the chest wall, pericardium, diaphragm, and left atrium are categorized as T3 or T4, which is regarded as locally advanced lung cancer. The purpose of this study was to evaluate results of surgical treatment of T3-4N0-2M0 non-small cell lung cancer according to involved organs. From 1981 to April 2005, 148 patients with lung cancer invading neighboring organs were surgically treated in our hospital. The 5-year survival was 41.4% in all cases. According to 5-year survival of clinical characteristics, the chest wall (parietal pleura) group (45.5%) had a significantly better prognosis compared with the left atrium (0%, p = 0.03) and diaphragm (0%, p = 0.04) groups. T3N0 (50.3%), IIB (55.4%), IIIA (44.6%), and complete resection groups (49.0%) showed a significantly better prognosis compared with T3N2 (27.9%, p = 0.01), III B (0%, p < 0.0001), and incomplete resection groups (13.9%, p < 0.0001), respectively. These results indicate that the prognosis of patients with N2 disease or incomplete resection remains poor in regardless with the type of involved organs.

[Perioperative management for lung cancer with interstitial pneumonia].

The purpose of this study was to review perioperative managements from the clinical features and the postoperative course of lung cancer patients with interstitial pneumonia (IP). Twenty-two patients with IP were divided into 2 groups: the acute exacerbation (AE) group (6 patients) and the non-acute exacerbation (NAE) group (16 patients). There was no significant difference in the patient background between the 2 groups. In hematological examination, KL-6 levels were significantly higher in the AE group than in the NAE group. There was no significant difference in the respiratory function tests in the both groups, and the heart rate after 2 flights test was significantly higher in the AE group than in the NAE group. There was no significant difference in operation-related factors, tumor-related factors and the postoperative course in the both groups. No postoperative death occurred in our 22 patients probably due to adequate treatments of IP which was managed by our detailed manual. Long-term follow-up for lung cancer patients with IP undergoing surgical intervention is needed to prevent AE.

Reconstruction of heavily calcified aorta and its visceral branches without extracorporeal circulation.

A 61-year-old Japanese female was referred to our hospital for surgical treatment of a localized heavily calcified abdominal aorta. Preoperative angiograms and computed tomograms revealed severe stenosis of the aorta, resembling a slit. Bypass grafting between the thoracic and abdominal aorta was successfully performed together with the reconstruction of the celiac artery, superior mesenteric artery, and bilateral renal arteries without extracorporeal circulation. Postoperative angiograms showed patency of the graft and branches. A localized heavily calcified abdominal aorta is relatively rare, and the cause of this entity might be Takayasu's aortitis.

[Evaluation of TNM classification for lung carcinoma with satellite nodules in the same lobe as the primary].

We conducted a validation of the treatment of satellite nodules in the UICC TNM classification of 1997. Over the past 17 years (1981 to 1997), 29 patients underwent complete pulmonary resection for primary lung cancer accompanied by satellite nodules in the same lobe as the primary. All these patients were categorized as stage IIIB according to the current staging system. The five-year survival rate of all patients was 40% and the figure was unduly better for stage IIIB patients. The three-year survival rate of 20 patients having lymphatic involvement were 18%, but those of 9 patients without it was 89%. Outcome was significantly influenced on their presence or absence of lymph node metastases. The current staging system for patients with satellite lesions in the same lobe appears to be unacceptable because they provide the different influences on prognosis and selecting treatment modality according to the N status.

Applying RUG-III in Japanese long-term care facilities.

A U.S. nursing home case-mix system, Resource Utilization Group, Version III (RUG-III), was tested in a variety of Japanese long-term care facilities. Staff time and resident characteristics were measured for a sample of 871 patients. Acceptable reliability was found for items defining RUG-III, and the system explained 44% of the variance in wage-weighted staff time (cost). Also, Japanese and U.S. costs had similar patterns across RUG-III categories. However, there was wide discrepancy between the stated purpose of Japanese facilities and their patient populations, and the current payment mechanism did not reflect actual use of resources.

[A case of oral tuberculosis suspected malignancy].

Oral tuberculosis with pulmonary tuberculosis is very rare in Japan. A 45-year old man admitted to our hospital because of spontaneous teeth extraction and pain in oral cavity for the past 3 months. The painful granulation in palate and fistel of 7th tooth root defect in right upper gum were observed. The diagnosis of oral tuberculosis was made by the histological examination of biopsy material and positive smear test for M. tuberculosis in surface of granulation. Chest X-ray showed multicavitary lesions in bilateral upper lobs and spread shadows in bilateral lower lung fields. He was treated with chemotherapy (INH, RFP, SM and EB) and with tube feeding. Five month's chemotherapy was needed to achieve cured granulation and negative smear test for M. tuberculosis in sputum. He was discharged 10 months after admission.

[A recovered case of serious lung tuberculosis on wanderer].

This report is a case study of a vagrant whose state of tuberculosis showed noteworthy improvement due to clinical treatment. A 54-year-old male, vagrant, was admitted to the hospital in a state of preshock because of a serious stage of lung tuberculosis. The clinical course was severe, but after three months of intensive care the patient recovered. It was noted that the echocardiogram taken after recovery revealed improvement when compared with the one taken upon admission, which showed remarkable right ventricular overload. Furthermore, anti-tuberculosis agents proved to be very effective in this case. The patients respiratory functions improved more markedly than had been expected. The reason for reporting this case study is to bring attention to the improvements in the patient's clinical course and echocardiographic findings. These suggest that tuberculosis in vagrants may differ from the usual stage of tuberculosis diagnosed in elderly persons in terms of response to anti-tuberculosis agents and potential recovery.