Comparison of different approaches in complete thoracoscopic segmentectomy of lung lower lobe.

Background: Safe and oncologically acceptable segmentectomy outcomes were reported for early-stage lung cancer. The high-resolution computed tomography allowed us to find detailed structures inside the lungs, such as the pulmonary ligaments (PLs). Hence, we have presented the relatively anatomically challenging thoracoscopic segmentectomy, for the resection of the lateral basal segment, the posterior basal segment, and both segments through the PL as a PL approach. This study aimed to retrospectively examine the lung lower lobe segmentectomy, excluding the superior and basal segments (from S7 to S10), using the PL approach as an option to treat the lower lobe tumors of the lung. We then compared the efficacy of the PL approach in terms of safety with the interlobar fissure (IF) approach. The characteristics of the patients, intra- and postoperative complications, and surgical outcomes were analyzed. Methods: Of the 510 patients who underwent segmentectomy for malignant lung tumors from February 2009 to December 2020, 85 were included in this study. Among them, 41 underwent a complete lung lower lobe thoracoscopic segmentectomy, excluding S6 and basal segments (from S7 to S10), using the PL approach, and the remaining 44 used the IF approach. Results: The median age in 41 patients in the PL group was 64.0 years (range, 22-82), and that in 44 patients in the IF group was 66.5 years (range, 44-88), with significant differences in gender between these groups. Video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery were performed on 37 and 4 patients in the PL group and 43 and 1 patient in the IF group, respectively. Postoperative complication frequency was not significantly different between these groups. The most common complications were the air leaks that persisted for over 7 days in 1 and 5 patients in the PL and IF groups, respectively. Conclusions: Complete thoracoscopic segmentectomy of the lower lobe, excluding S6 and basal segments, using the PL approach is a reasonable option for lung lower lobe tumors compared with the IF approach.

Regioisomeric allene dimer formation by the reaction of tetraarylbutatrienes with tetracyanoethene.

The reaction of tetraarylbutatrienes (tetraaryl[3]cumulenes) with tetracyanoethene (TCNE), a strong electron-accepting molecule, at room temperature yielded novel four-membered ring compounds (head-to-tail unsymmetrically substituted diarylallene dimers) by [2 + 2] cycloaddition of the central C=C bond of the butatrienes. This reaction proceeded through a head-to-head symmetrically substituted diarylallene dimer intermediate. Unsymmetrical butatriene also formed a small amount of another head-to-tail dimer. Although the allene dimer is stable in nonpolar solvents, it converts to other bicyclic and tricyclic compounds in MeOH or CH3CN at room temperature.

Thermal cyclotrimerization of tetraphenyl[5]cumulene (tetraphenylhexapentaene) to a tricyclodecadiene derivative.

Tetraphenyl[5]cumulene (tetraphenylhexapentaene) underwent cyclotrimerization in refluxing toluene for 10-15 min to give a tricyclodecadiene derivative in 68% yield.

Regioselective synthesis of 6-alkyl- and 6-prenylpolyhydroxyisoflavones and 6-alkylcoumaronochromone derivatives.

The palladium-catalyzed coupling reaction of 6-iodoisoflavone, prepared from 3'-iodoacetophenone derivative, with 2-methyl-3-butyn-2-ol gave 6-alkynylisoflavone derivative, which was hydrogenated to give 6-alkylhydroxyisoflavone (luteone hydrate) (2). Dehydration of 2 gave 2',4',5,7-tetrahydroxy-6-prenylisoflavone (luteone) (1). Wighteone hydrate (3) was also synthesized from 6-iodotris(benzyloxy)isoflavone in a similar manner. 6-Alkyl-4'5,7-trihydroxy-coumaronochromone (4) was synthesized by oxidative cyclization of 2 with o-chloranil.

Long-term survival in adult mediastinal neuroblastoma.

Neuroblastoma rarely occurs in adults, in whom prognosis is poor. Here we report on the effective use of multimodal therapy to achieve long-term survival in adult mediastinal neuroblastoma. In a 33-year-old male with severe pain radiating from the left hypochondrium to the back area, no abnormal shadow was detected on first examination; the shadow appeared in chest X-ray only 10 months later when the severe pain recurred. The patient was then referred to our department for further examination. Chest X-rays and chest CT scans revealed a posterior mediastinal mass beside the thoracic vertebrae. Diagnosis was confirmed after surgical resection, which was followed by outpatient adjuvant therapy through radiation and chemotherapy. The patient has survived 8 years and 8 months without recurrence or metastasis.

Bronchoplasty with plication of the proximal bronchial membranous portion.

Bronchoplasty originally designed for patients with inadequate pulmonary function who cannot tolerate pneumonectomy, has recently yielded good results as well as offering an alternative to pneumonectomy. We describe a technique for plication of the proximal bronchial membranous portion when there is significant discrepancy in lumen size between the main and the segmental bronchi to allow precise end-to-end anastomosis. Plication helps prevent postoperative anastomotic stenosis and obstruction.