[A patient with pleural thickening of sarcoidosis].

We report a 51-year-old woman with characteristic pleural involvement of sarcoidosis. Video-assisted thoracoscopic examination identified diffuse pleural thickening in the right lung, which coincided in distribution with parenchymal reticular shadows demonstrated with high-resolution thoracic CT scan. Biopsied specimens revealed epithelioid cell granuloma with noncaseating necrosis and multi-nucleated giant cells in the parenchymal lung tissue. Infiltration of inflammatory cells was demonstrated in the thickened pleural tissue, but no typical sarcoid lesion. This pleural lesion was considered as pleural involvement of sarcoidosis, since deterioration of the pleural thickening was accompanied with progression of a parenchymal sarcoid lesion during the period of two months after biopsy. Video-assisted thoracoscopy and high-resolution CT scan both supported the diagnosis of sarcoidosis with pleural involvement.

Enhanced induction of apoptosis in lung adenocarcinoma after preoperative chemotherapy with tegafur and uracil (UFT).

PURPOSE: To determine if the preoperative administration of tegafur and uracil (UFT) to patients with lung adenocarcinoma could induce apoptosis. METHODS: We conducted a randomized prospective study on 30 patients with lung adenocarcinoma, divided into two groups of 15 patients each. One group received UFT 600 mg/day preoperatively for 7 consecutive days and a control group received no chemotherapy or radiotherapy. The apoptotic index (AI) was determined by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end-labeling (TUNEL) method. Expression of Ki-67 was examined by immunohistochemical staining. The concentration of 5-fluorouracil (5-FU) in tumor tissue was measured by chemical assay. RESULTS: The AI of lung adenocarcinoma cells increased significantly in the UFT-treated group but not in the control group. A significant positive correlation was seen between the AI and the 5-FU concentrations in the tumor tissue. CONCLUSIONS: The continuous oral administration of UFT for 7 days preoperatively resulted in enhanced apoptosis and a significant positive correlation between the AI and 5-FU concentrations in lung adenocarcinoma. Therefore, it may be possible to evaluate the effects of adjuvant chemotherapy based on the AI.

Transposition of modified latissimus dorsi musculocutaneous flap in the treatment of persistent bronchopleural fistula after posterolateral incision.

The condition of a 51-year-old man was complicated with empyema and bronchopleural fistula (BPF) after left upper lobectomy and thoracoplasty for pulmonary aspergillosis. On the postoperative day (POD) 12, the opened bronchial stump was directly closed and covered with a pedicled pectoralis major muscle flap. On POD 66, an open-window thoracostomy was done, because of empyema with Pseudomonas aeruginosa Two years later, we could fill the empyema cavity, and close the multiple BPFs with the transposition of a modified pedicled musculocutaneous (MC) flap and the additional thoracoplasty to gain good quality of life. Although the MC flap was a proximal part of the latissimus dorsi muscle, which was dissected along the posterolateral incision of the first operation, it could be successfully transplanted to cover the BPFs in the open-window. In some patients with a small open-window on the upper anterior chest wall, the pedicled proximal latissimus dorsi MC flap may be very useful for treating persistent BPFs even after a standard posterolateral incision.

Surgery for Mycobacterium avium complex lung disease in the clarithromycin era.

OBJECTIVE: Since the introduction of clarithromycin, it has been assumed that pulmonary Mycobacterium avium complex (MAC) disease can be treated with medication alone. This study examines whether surgery can still play an important role in the management of MAC lung disease in the current era. METHODS: Between April 1993 and January 2001, 21 patients (11 men and 10 women) underwent a pulmonary resection for MAC infection. The median age of the patients was 56 years (range: 27-67 years). None of the patients were immunocompromised. Regimens employing clarithromycin were initiated preoperatively in all patients. The indications for surgery were failure of drug therapy in 19 patients and discontinuation of chemotherapy because of drug toxicity in two patients. The pulmonary resections (19 right lung, 2 left lung) performed included lobectomy in 16 patients, pneumonectomy in three, bilobectomy in one, and lobectomy plus segmentectomy in one. RESULTS: All of the patients survived the surgery. Six major postoperative complications occurred in six patients (28.6%) and these included two bronchopleural fistulas after right pneumonectomy, two space problems, one prolonged air leak, and one case of interstitial pneumonia. All postoperative complications were manageable, and four of these were treated surgically. All patients had sputum-negative status after their operation. Relapse occurred in two patients (9.5%) at six months and two years postoperative, respectively. The first patient, who originally had a right upper lobectomy, underwent a left upper lobectomy during the follow-up period, attaining sputum conversion. The second patient underwent a right pneumonectomy and then died of respiratory failure four years postoperatively. This one late death was the only fatality. CONCLUSIONS: Although it is associated with relatively high morbidity, surgery provides a high sputum conversion rate for patients whose MAC disease responds poorly to drug therapy. Even in the present clarithromycin era, pulmonary resection remains the treatment of choice when MAC lung disease has not been successfully eradicated by drug treatment alone.