[Intractable pneumothorax for pleuritis carcinomatosis effectively treated with bronchial embolization: report of a case].

A 57-year-old female was admitted with compliant of cough and body weight loss. Chest X-ray and thoracic computed tomography (CT) scan revealed a collapsed lung and pleural effusion. We diagnosed a pleulitis carcinomatosis. After right chest tube drainage was performed, she developed right intractable pneumothorax. It was occluded endobronchially by the placement of vascular embolization coils and histoacryl. This method is thought to be an effective treatment for intractable pneumothorax patients in endstage of lung cancer.

The predictive value of vascular endothelial growth factor and nm23 for the diagnosis of occult metastasis in non-small cell lung cancer.

We assessed the association of vascular endothelial growth factor (VEGF) and nm23 expression with occult micrometastasis in lung cancer. As destination sites for micrometastasis, we scrutinized lymph node (LN) and bone marrow (BM) specimens. For LN, 122 stage I patients who had received curative operations were studied. As regards BM, 203 patients in stage I - IV who underwent operations were registered. Immunohistochemical anti-cytokeratin staining was used to detect microdissemination of cancer cells. The VEGF and the nm23 expression at the primary sites were immunohistochemically studied in 285 cases in total. The percentages of the patients with microdissemination were 28.7% for LN and 42.4% for BM. The outcome for the patients with LN or BM microdissemination was significantly worse than that for patients without it. The increased VEGF and the decreased nm23 expression within primary tumors were significantly associated with LN and BM microdissemination. The results indicate possible value of using these biological markers to predict the risk of systemic micrometastasis in non-small cell lung cancer.

Surgical management of early stage central (hilar) and peripheral nonsmall cell lung carcinoma.

BACKGROUND: To the authors' knowledge, the definitions of early lung carcinoma used in Japan are not yet approved internationally. In the current study the diagnostic methods, pathology, and results of the surgical treatment of early hilar and peripheral nonsmall cell lung carcinoma cases defined by Japanese criteria are presented. METHODS: Between 1977 and 1998, 43 patients with early hilar lung carcinoma were encountered. These patients constituted 14.5% of 200 hilar lung carcinoma patients who underwent resection during the same period. Between 1973 and 1998, there were 174 early peripheral lung carcinomas, which comprised 14.8% of 1173 peripheral lung carcinoma patients who underwent resection during the same period. RESULTS: The 5-year and 10-year survival rates of the early hilar lung carcinoma were 100% and 96.9%, respectively. The majority of the patients underwent bronchoplastic surgery, such as sleeve lobectomy and parenchymal-sparing surgery including seven sleeve segmentectomies and two second carinal resections. The effectiveness of the parenchymal-sparing resections was assessed by the conventional pulmonary function test as well as perfusion and ventilation scanning. There were 174 cases of peripheral early lung carcinoma among the 218 cases of peripheral lung carcinoma with tumor dimensions of < or = 2 cm. The cell types were 142 (81.6%) cases of adenocarcinoma, 18 (10.3%) cases of squamous cell carcinoma, and 14 (8%) cases of other cell types. These 174 patients comprised 14.8% of 1173 patients with peripheral nonsmall cell lung carcinoma who underwent surgery during the same period. The 5-year and 10-year survival rates for adenocarcinoma were 89.6% and 86.8%, respectively. The 5-year and 10-year survival rates for other cell types were both 71.8%. The overall 5-year and 10-year survival rates were 86.8% and 84.6%, respectively. CONCLUSIONS: Early lung carcinoma in both the hilar and peripheral regions, is curable if it is properly diagnosed and treated.

[Surgical results on N2 lung cancer with special reference to correlation between tumor size and extension of lymph node metastases].

Systematic lymph node dissection was performed for every patients undergoing surgical intervention. Since 1981, there were 218 stage IIIA-N2 patients who underwent resection with two operative mortality. The five-year survival rate of whole cases was 22.6%, and that of 152 completely resected cases was 30.0%. Favorable factors on long-term survival of pN2 patients were cN0, T1-2 N2M0, single mediastinal node involvement, and tumor less than 20 mm or less. The five-year survival rates of stage IIIA-N2 patients with tumor diameter of < or = 20 mm, 21-30 mm, 31-50 mm, and > or = 51 mm were 48.1%, 27.7%, 31.2%, and 16.7%, respectively. When micrometastases to lymph node in the p-stage I patients (diagnosed by H-E staining) were examined by immunohistochemical staining, 36 patients (27%) out of 132 verified micrometastases in the lymph nodes.

[Extended resection of the great vessels for primary lung cancer and mediastinal tumor].

From 1973 to 1998, we resected and reconstructed the great vessels in 44 patients with primary lung cancer or mediastinal tumor. Among them, 39 patients (28 with lung cancer and 11 with mediastinal tumor) and 5 patients (all with lung cancer) underwent reconstruction of the superior vena cava (SVC) and aorta, respectively. The SVC was repaired by expanded polytetrafluoroethylene (EPTFE) graft (n = 8), prosthetic patch (n = 5) or direct suture (n = 26). The aorta was repaired with temporary subclavian artery-descending aorta (n = 3), or left atrium-femoral artery bypass (n = 2). No complication or operative death occurred after surgery. The survival rate of the patients with lung cancer who underwent SVC reconstruction at 3 year and 5 year were 26.2% and 11.2%, respectively. Five of 11 (45.5%) patients with mediastinal tumor are alive at 5 years. We concluded that extended resection for primary lung cancer or mediastinal tumor invading the SVC is acceptable operation method for some patients.

Surgical drainage for idiopathic suppurative pylephlebitis.

Idiopathic suppurative pylephlebitis is quite rare and only a few cases have been reported. Conservative systemic administration of antibiotics and urokinase is reported to be effective. In this report, surgical drainage was performed on an 18-year-old man who complained of fever and abdominal pain. He had no past history of abdominal inflammatory disease or abdominal surgery. Ultrasonography and computed tomography showed wide spread thrombosis of the portal vein. Laparotomy was performed and the occluded superior mesenteric vein was incised. Massive pus was removed. Thereafter, a drain was placed at the opened mesenteric vein. Drainage resulted in a dramatic decrease in fever. Postoperative radiographic studies of the colon, the small intestine, and other organs did not show any abnormalities. Emergency surgical drainage was performed successfully, instead of systemic administration of antibiotics and urokinase. Surgical drainage may be useful for wide spread pylephlebitis and pylethrombosis.