Video-assisted thoracic surgery for lung cancer in hemodialysis patients.

INTRODUCTION: In recent years, the number of hemodialysis patients has been continuously increasing. At the same time, the use of video-assisted thoracic surgery (VATS) for lung cancer has also increased. However, reports of the outcome of VATS in hemodialysis patients are still quite rare. METHODS: From 1995 to 2011, 14 patients with non-small cell lung cancer who were also receiving hemodialysis underwent lung resection by open thoracotomy or VATS at our institution. These patients were divided into two groups as follows: open (five men and four women, mean age: 68.7 years) and (2) VATS (three men and two women, mean age: 64.0 years). We compared the clinical outcomes of these two groups. RESULTS: Lobectomy was performed in eight patients in the open group, including one patient who also underwent a pneumonectomy, and in four patients in the VATS group, including one who also underwent a wedge resection. There were no significant difference between the groups' operation times, intraoperative blood loss, length of postoperative chest drainage, and length of postoperative hospitalization. There were no hospital deaths in either group. The 5-year survival rate was 42.9% in the open group and 37.5% in the VATS group. This difference was not significant (P=0.73). CONCLUSION: VATS lung resection for lung cancer patients on hemodialysis is considered an acceptable treatment modality, though the long-term survival rate of such patients is relatively low, which can be attributed to the diseases underlying the need for hemodialysis.

Prognosis of patients after pulmonary artery plasty for non-small cell lung cancer.

OBJECTIVE: We evaluated the clinical outcomes of patients after lung resection with pulmonary artery (PA) plasty for non-small cell lung cancer (NSCLC). METHODS: From 1995 to 2006, 36 patients (26 males and 10 females) with NSCLC underwent lobectomy or segmentectomy with PA plasty at our institution. The mean age of the patients was 65.9 years old (range 45-87 years old). There were 17 left upper lobectomies, 10 right upper lobectomies, five left lower lobectomies, two right upper-and-middle bilobectomies, one right lower lobectomy, and one left upper division segmentectomy. Both bronchoplasty and PA plasty were performed in 15 patients. Six patients received preoperative chemotherapy, and one had preoperative radiotherapy. RESULTS: The postoperative morbidity rate was 27.8 % (10/36), and the mortality rate (30 days) was 2.8 % (1/36). One patient underwent completion pneumonectomy on postoperative day 13. Macroscopic residual cancer was identified in two patients at the thoracic wall and aorta, respectively; microscopic residual cancers were identified in two patients at the stumps of the pulmonary artery and in one patient at the bronchial stump. Postoperative radiation therapy was additionally given to those four patients, except one. The 5-year survival rate for all patients was 51.8 %. There was no significant difference in the 5-year survival rate between clinical N (cN) 0-1 patients and cN2 patients. However, in pathological N (pN) 0-1 patients, the 5-year survival rate was significantly better than that of pN2 patients (71.9 % versus 0.0 %; P < 0.001). CONCLUSIONS: PA plasty for NSCLC is acceptable and highly recommended for pN0-1 patients. Strict patient selection should be considered so as to avoid surgical operations in patients with pN2 staging.

[Bronchial lipoma treated by surgical resection; report of a case].

We report a case of bronchial lipoma, which relapsed after endoscopic treatment, and was treated by surgical resection. An abnormal shadow on chest X-ray was noted at the annual medical checkup of a 44-year-old man. Chest computed tomography (CT) demonstrated a tumor in the right basal bronchus and linear opacity on the peripheral side of that tumor. Bronchoscopic examination demonstrated a smooth polipoid tumor occluding the right basal lobe bronchus. Bronchoscopic biopsy specimens were not sufficient for histological diagnosis. We performed endobronchial resection of the tumor using electrosurgical snare, but 2 months after endoscopic treatment, the tumor relapsed. We therefore performed right S(9+10) segmentectomy. The tumor was 11 x 9mm in size and the histological diagnosis was an endobronchial lipoma. More than 4 years after resection, the patient is alive without recurrence.

Streptococcal origin of a case of Henoch-Schoenlein purpura nephritis.

We report the case of a 25-year-old man with abdominal pain, purpura on the legs and proteinuria occurring 2 weeks after acute tonsillitis, and admitted to our hospital with suspected Henoch-Schönlein purpura nephritis (HSPN). He had increased anti-streptolysin O (ASO) titer and hypocomplementemia. A renal biopsy specimen showed endocapillary proliferative changes, which are typical of acute poststreptococcal glomerulonephritis (APSGN). However, immunofluorescence study revealed predominant IgA and C3 deposits in mesangial lesions, indicating a diagnosis of HSPN. Because of massive proteinuria initially, the treatment with a combination of prednisolone, cyclophosphamide, dipyridamole and warfarin was started along with 3 plasma exchanges. Angiotensin-converting enzyme inhibitor was also given. Response to the treatment was favorable. A follow-up biopsy was performed 8 months after the first biopsy. The renal biopsy specimen showed a figure of typical HSPN. To further investigate the cause of glomerular changes in our patient, an immunofluorescent study of nephritogenic nephritis-associated plasmin receptor (NAPlr) of group A, beta-hemolytic streptococci was performed. NAPlr was significantly positive in the glomeruli in the first biopsy specimen, but not in the second. His clinical course and pathological findings suggest that NAPlr may be related to the pathogenesis in a part of patients with HSPN, especially in patients with high ASO titer and hypocomplementemia.

[Thoracolithiasis detected during video-assisted thoracoscopic surgery for spontaneous pneumothorax: report of a case].

A 32-year-old male was admitted to our hospital for treatment of right recurrent spontaneous pneumothorax. Chest X-ray showed right pneumothorax but chest X-ray and computed tomography (CT) examinations did not demonstrate intrathoracic abnormal mass shadow or abnormal calcifications. We performed video-assisted thoracoscopic surgery for spontaneous pneumothorax. At surgery, an egg-shaped milky white free mass was found in the thoracic cavity, and easily removed. This substance was hard and smooth on the surface and measured 12 x 9 mm. Histologically this mass was composed of fatty necrosis surrounded by hyalinized connective tissue. These findings led to a diagnosis of thoracolithiasis. Thoracolithiasis without any history of chest trauma or intervention is pathologically rare, with only 15 cases including our case in Japan, having been reported in the literature to date.

Minimal change nephrotic syndrome, lymphadenopathy and hyperimmunoglobulinemia after immunization with a pneumococcal vaccine.

A 67-year-old female was admitted to our hospital with eruption and cervical lymphadenopathy which occurred one week after pneumococcal vaccination. Polyclonal hyperimmunoglobulinemia (IgG 6,620 mg/dl) and mild plasma cell proliferation (6.4%) in a bone marrow specimen were found, but a lymph node aspiration biopsy showed no specific findings. Normochromic and normocytic anemia with a positive direct Coombs test were also confirmed. Short-term intensive steroid therapy was given, but the systemic eruption and lymphadenopathy continued. About 4 months after vaccination, she suffered from edema in her face and legs and visual disturbance. When massive proteinuria (10.4 g/day) was found, she was admitted to our ward. A renal biopsy specimen showed a minor glomerular abnormality with mild interstitial plasmacytic infiltration. An abdominal CT scan showed hepatosplenomegaly and para-aortic lymphadenopathy. Uveitis was also found by ophthalmoscopy. These abnormalities completely disappeared after intensive steroid therapy including pulse therapy. On the basis of her clinical course and laboratory findings, it was suggested that minimal change nephrotic syndrome might be induced after vaccination, possibly due to hypersensitivity syndrome.

Specific targeting strategies of cancer gene therapy using a single-chain variable fragment (scFv) with a high affinity for CEA.

Two specific targeting strategies of cancer gene therapy using carcinoembryonic antigen (CEA) as a target are briefly reviewed here. One method is the specific targeting of suicide genes to CEA-expressing tumor cells by a retrovector displaying anti-CEA single-chain variable fragment (scFv). We reconstructed a recombinant retroviral vector that displays both anti-CEA scFv-expressing chimeric and normal envelope proteins and carries the inducible nitric oxide synthase (iNOS) gene. This recombinant retrovirus specifically bound, infected and killed only CEA-expressing tumor cells, indicating the cell specific retroviral vector delivery of the iNOS gene. Another novel method is the specific redirecting of cytotoxic T-cells to CEA-expressing tumor cells through chimeric receptors. We also reconstructed a chimeric receptor gene which encoded an anti-CEA scFv antibody and the zeta-chain of human TCR/CD3 complex and expressed it on T-cell surface. When incubated with CEA-expressing tumor cells in vitro, the transduced T-cells tended to make a rosette-like formation around the tumor cells, suggesting the cell specific targeting of T-cells.

Osseous primitive neuroectodermal tumor--a case report.

PNET and Ewing sarcoma are pathologically distinct entities with very similar clinical and radiological characteristics. Immunohistochemical studies are needed to distinguish PNET from Ewing sarcoma, with the former being characterized by neural differentiation. We present the case of a 17-year-old man with immunohistochemically confirmed PNET in the cervical vertebrae.

Primary tracheal fibrosarcoma in a child: a case of tracheal resection under ECMO support.

We report a case of severe airway obstruction due to endotracheal fibrosarcoma in a 3-year-old boy. Successful tracheal resection and reconstruction was performed under extracorporeal membrane oxygenation support. A solid, elastic hard tumor with a smooth surface was attached by a tiny stalk structure to the membranous part of the lower trachea. Histological findings of the tumor were consistent with infantile fibrosarcoma, showing proliferation of spindle cells forming interlacing patterns.

Case of ageusia from a variety of causes.

We report a case of a 31-year-old woman with ageusia. Her ageusia was related to a variety of causes including an unbalanced diet, administration of the anti-epileptic drug, carbamazepine and psychological factors. Her taste function recovered after stopping the carbamazepine and treatment with liver extracts and zinc sulphate.

[Gas ventilation through middle ear mucosa].

The possible effects of gas ventilation via the middle ear mucosa on middle ear pressure changes with N2O inhalation were studied. Sixty-seven ears without otologic problems were selected from among cases undergoing ENT surgery under general anesthesia. Anesthesia was induced by isoflurane or sevoflurane, and inhalation with a gas mixture of 21/min O2 and 31/min N2O was started under controlled respiration via endotracheal tube. Middle ear pressure was measured each minute with tympanometry just before and during N2O inhalation. Changes in pressure were plotted against time on an X-Y plotter, and the rate of middle ear pressure change and pressure change in 10 minutes were calculated. The following results were obtained; 1. In all cases, the middle ear pressure rose with N2O inhalation. However, the same concentration of N2O created different middle ear pressure changes in different individuals varying from 1.6 mmH2O to 107.8 mmH2O per minute. 2. The rate of middle ear pressure elevation tended to be greater in younger subjects, especially in children aged 4 to 7. 3. There was a negative correlation between the middle ear pressure change and pneumatization of the middle ear. 4. Sex, pulmonary function, and the N2O expiratory flow concentration did not contribute to the variability in the rate of the middle ear pressure elevation.