Risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients: a retrospective study in Japan.

The present study aimed to reveal; i) risk for prolonged hospitalization and mortality in aged community acquired pneumonia patients, and ii) whether swallowing ability was related to re-hospitalization. The present retrospective study included 92 patients older than 75 years hospitalized with community acquired pneumonia in Takagi Hospital between April 2017 and March 2018. The patients were classified into 3 groups; discharged within 17 days (group I): hospitalized more than 18 days (group II): died during the hospitalization (group III). Swallowing ability was evaluated if available. Univariate analysis indicated males and body mass index (BMI) in group I (n = 24) were higher than group II (n = 46). Group III (n = 22) had low serum albumin, low BMI, and severe disease progression compared with group I. Multivariate analysis demonstrated that group II BMI was lower than group I [odds ratio (OR) = 1.18, p = 0.042]. Group III had lower serum albumin level compared with group I (OR = 81.01, p = 0.025). Diabetes mellitus (p = 0.009), but not swallowing disability, was risk for readmission. Malnutrition represented by low albumin enhanced mortality rate in the pneumonia patients, and low BMI and diabetes mellitus might increase the pneumonia risk.

[Pneumopericardium 4 Years after Surgery of Thymic Cancer].

A 67-year-old man had undergone thymectomy with partial resection of the left upper lobe and pericardium for thymic cancer. Four years later, he visited our hospital due to chest pain. Chest computed tomography revealed pneumopericardium. Nine months later, surgical treatment was performed due to the development of the left pneumothorax. Air leak was found from the bulla which was partially incarcerated into the pericardial space.

Metachronous bilateral pulmonary metastases from cancer of the ampulla duodeni.

We present a 76-year-old man who underwent two lung resections for metastases originating from cancer of the Ampulla duodeni, 9 years-after pancreaticoduodenectomy with lymphadenectomy. Pancreaticoduodenectomy was performed in 2002; histological examination of the original tumor revealed a stage III tubular adenocarcinoma (pT3, N0, M0). Repetitive lung resection was performed in 2007 (left S8) and 2011 (right S1 and extirpation of a pericardial cyst). Although rarely performed, resection of bilateral pulmonary metastases from carcinoma of the papilla of Vater was done to improve the patient's chances for longterm survival.

[Simultaneous resection of lung and liver metastases due to uterine leiomyosarcoma; report of a case].

We describe a case of simultaneous resection of lung and liver metastases from uterine leiomyosarcoma, with reference to previous reports. A 51-year-old female was admitted for treatment of nodules shadow in the right lung and in the left lateral side of the liver discovered by computed tomography (CT). She had been treated for uterine leiomyosarcoma 19 months earlier. Segmentectomy of the right S6 of the lung and left lateral segmentectomy of the liver were performed. The tumors pathologically diagnosed as metastases from uterine leiomyosarcoma. After 29 months, a metastasis to the left lung was detected and thoracoscopic resection was performed. The patient died due to multiple metastases from uterine leiomyosarcoma after 36 months.

Pulmonary papillary adenoma.

We present a rare case of solitary pulmonary papillary adenoma. A man consulted our hospital because of abnormal chest radiography finding. Chest computed tomography demonstrated a well-defined, homogeneous nodular shadow 11 mm in size at the left lower lobe. The previous physician had considered it to be an old benign inflammatory granuloma and had kept it under observation. This mass was followed through chest radiographs at annual medical checkups for 4 years. In 2006, enlargement and lobulation were noted. We performed thoracoscopic partial resection of the left lower lobe. On postoperative pathology examination, the nodule was found to be a circumscribed nodule consisting of a papillary growth of cuboidal to low-columnar epithelial cells lining the surface of a fibrovascular stroma. The histological features were consistent with pulmonary papillary adenoma. Only 20 cases of pulmonary papillary adenoma have been reported in the literature.

[Simultaneous surgical case of thymoma combined and non small cell lung cancer; report of a case].

We described a case of simultaneously treated thymoma associated with lung cancer, with reference to previous reports. A male in his forties who was pointed out a mediastinal mass and a nodular shadow in the right lower lung field on chest X-ray was admitted to our hospital. The resection of right lower portion of thymus and right lower lobectomy of the lung were performed. The mediastinal mass appeared to be a thymoma. Although thymomas associated with lung cancer are uncommon, the relationship between thymomas and the incidence of nonthymic malignancy is discussed in several papers. Since lung cancer is increasing in our country, thymoma associated with lung cancer are expected to increase.

A small randomized phase III single-center trial on postoperative UFT administration in patients with completely resected non-small cell lung cancer.

Our objective was to clarify the efficacy of UFT administration after the complete resection of non-small cell lung cancer (NSCLC) at a single-center institution, avoiding the biases produced by interinstitutional differences. A total of 30 patients who underwent the complete resection of NSCLC at our hospital between 1987 and 2001 were randomly assigned to a control group or to a UFT group (400 mg/day for 2 years). Thirteen patients were assigned to the control group and 17 patients were assigned to the UFT group. The overall survival rate, disease-free survival rate, patient compliance and adverse effect of the UFT treatment were then analyzed. The overall survival and disease-free survival rates of the UFT group were superior to those of the control group. Four patients in the UFT group received medication for 24 months and 14 patients were treated for more than 3 months. No severe adverse effects were observed. Seven patients suffered a relapse in the control group. Two patients suffered a relapse in the UFT group, but the relapse occurred after the discontinuation of UFT administration. We conclude that the administration of UFT as an adjuvant therapy prolonged the overall survival and disease-free survival rates of patients after the resection of NSCLC in a small study performed at a single institution. Interinstitutional differences, particularly operating procedures, should be carefully considered when performing large multicenter clinical studies.

Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) levels, as prognostic indicators in NSCLC.

OBJECTIVES: Non-small cell lung cancer (NSCLC) tissue produces numerous growth factors, which are multifunctional and considered predictive of patient survival. This study sought to evaluate the relationship between concentrations of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF) in NSCLC tissue and clinicopathological factors, and determine whether these factors correlate with long-term survival. METHODS: We retrospectively investigated 71 patients with histologically confirmed adenocarcinoma or squamous cell carcinoma of the lung, for whom the primary curative approach was surgery, and who received no chemotherapy or radiotherapy prior to surgery. bFGF, VEGF, HGF were measured in extracts prepared from these 71 frozen tissue samples by ELISA. Five- and 10-year survival was obtained to determine the most important predictors of long-term survival. RESULTS: Among clinicopathological parameters, the mean concentration of bFGF was significantly higher in tissue extracts from cases involving metastatic nodal involvement (87.5+/-69.3 ng/100 mg protein) than in those without nodal involvement (57.6+/-42.5 ng; P<0.05). Levels of VEGF in adenocarcinoma (26.8+/-34.0 ng) were higher than for squamous cell carcinoma (12.2+/-13.8 ng; P<0.05). HGF levels also demonstrated histological differences (14.7+/-7.7 vs. 10.6+/-9.7 ng, P<0.05). bFGF protein levels were basically the same, but showed no statistically significant differences with respect to histological type (72.5+/-55.2 vs. 63.6+/-51.5 ng). Patients with high levels of bFGF or VEGF showed significantly worse survival rates than patients with low levels (P=0.0059; P=0.0134). In particular, high concentrations of both bFGF and VEGF correlated with markedly poor prognosis (P<0.0001). Multivariate analysis indicated that lymph node involvement and levels of bFGF and VEGF were independent prognostic factors in cases of NSCLC (adenocarcinoma or squamous cell carcinoma) involving patients who had undergone curative resection. CONCLUSIONS: Adenocarcinoma associated with lung cancer is regarded to have biological characteristics that distinguish it from squamous cell carcinoma. Node invasion may be associated with bFGF. bFGF and VEGF augment each other and are associated with leading to poor prognosis. The results of this study suggests that effective therapy to block angiogenesis may need to address at least both of these factors in cases of NSCLC.