[Oral Rehydration Therapy in Thoracic Surgery].

The purpose of this study is to evaluate the safety and the efficacy of preoperative oral rehydration therapy comparison with infusion therapy in thoracic surgery. Eighty-four patients scheduled for thoracic surgery were assigned to an oral rehydration group or an infusion group. We checked the amount of their urine and performed blood and urine test. And we carried out questionnaire concerning preoperative therapies to these patients. No morbidity concerned with preoperative therapies was encountered. There was no significant difference in blood and urine test in 2 groups. The answer of questionnaire showed more difficulties in the preoperative period in the infusion therapy group. Present study showed that the preoperative oral rehydration therapy could be done as safely as the infusion therapy with less difficulties compared to the infusion therapy even in the field of thoracic surgery.

Long-term outcome of nitinol stenting to treat asphyxia caused by postpneumonectomy syndrome.

The long-term outcome of nitinol stents introduced into a patient with postpneumonectomy syndrome is described. Postpneumonectomy syndrome is a rare but crucial complication after pneumonectomy characterized by severe dyspnoea and recurrent airway infection caused by compression of the main bronchus. Surgical correction of mediastinal displacement and endobronchial stent placement are two major treatments for this complication; however, endobronchial stenting may be limited to those who are not suitable for operative procedures because long-term management is difficult in terms of controlling airway infections. A patient in whom we introduced double nitinol stents was successfully rescued from an emergent situation; unfortunately, he ultimately succumbed to recurrent pneumonia due to Pseudomonas aeruginosa 12 years after stent insertion.

Fatal broncho-pulmonary artery fistula after lobectomy for lung cancer†.

A broncho-pulmonary artery fistula is one of the most fatal complications of lung cancer surgery. This article discusses the case of a patient who died of massive hemoptysis after a left upper lobectomy. There were no previous signs of broncho-pleural fistula except for an obstinate dry cough and slightly elevated serum C-reactive protein levels after surgery. An autopsy revealed that a fistula had formed between the bronchial stump and the pulmonary artery, leading to prolonged inflammation and ultimately a broncho-pulmonary artery fistula. The left lobectomy and right upper sleeve resection are the procedures most affected by this complication, according to the reviewed literature. The median period from the surgery to the events is 4 weeks. Abrupt onset of recurrent hemoptysis in that period is the most critical sign that should not be ignored.

[The fluorodeoxyglucose-positron emission tomography (FDG-PET) findings and surgical strategy for pulmonary sclerosing hemangioma].

The pulmonary sclerosing hemangioma is a comparatively rare lung tumor. We operated on 7 patients of the pulmonary sclerosing hemangioma during January, 2009 from December, 2001. We collected the information such as preoperative image findings, surgical methods, and the postoperative course. FDG-PET was performed in 4 patients preoperatively, and there was FDG uptake in 2 patients, and no FDG uptake in 2 patients. In 2 cases with FDG uptake, there was a tendency to increase the tumor diameter during preoperative follow-up. Among 7 patients, 1 patient underwent tumor enucleation, 2 patients underwent partial resection, and 2 patients underwent thoracoscopic lobectomy. Lung biopsy was performed in remaining 2 cases. Because a tumor was located in pulmonary hilum in 1 case, we underwent lung needle biopsy under thoracoscopy. Because another case was a multiple case, and the resection of all lesions was impossibile, we performed lung biopsy (partial resection). In all cases, the recurrence or exacerbation of the tumor was not detected postoperatively. We thought that the findings of FDG-PET reflected proliferation potency of the pulmonary sclerosing hemangioma. The clinical features of the pulmonary sclerosing hemangioma are various. Therefore, the surgical treatment should be determined in each case carefully while considering the FDG-PET findings.

c-myc amplification and enhancement of sensitivity to cytosine arabinoside: an in vitro and in vivo study on four sublines established from a pulmonary adenocarcinoma.

PURPOSE: Meticulous treatment strategies taking tumor heterogeneity into account are considered essential to achieve breakthroughs in current cancer therapy. We analyzed tumor heterogeneity in the primary tumor of a patient with pulmonary adenocarcinoma characterized by a poor prognosis. METHODS: Four sublines with different growth characteristics in vitro were established from the tumor using a method for short-term selective cultivation. We examined the differences in morphological, biochemical, and genetic findings of these sublines. RESULTS: Differences in the histological features of the transplanted tumors were seen in the four sublines. The 88-2T and 88-2 tumors revealed a well-differentiated adenocarcinoma; the 88-2F tumor revealed a large cell-like carcinoma resembling the metastatic tumor in the lymph nodes; and the 88-2FA tumor was composed of signet-ring cells. There were differences in oncogenes, with the 88-2F line alone exhibiting 12-fold amplification of c-myc. Sensitivity to cytosine arabinoside (Ara C) was specifically increased in the 88-2F cell line, alone. CONCLUSIONS: These sublines demonstrate that human pulmonary adenocarcinoma has various types of heterogeneity within the primary tumor. Furthermore, c-myc amplification may play an important role in altering phenotype and growth characteristics in vitro and in vivo, and for increasing sensitivity to Ara C and the potential of cancer cells to metastasize to lymph nodes.