Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery.

Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.

Clinical outcomes and prognostic factors of cone-beam CT-guided radiofrequency ablation for pulmonary metastases in colorectal cancer patients.

AIM: Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases in various malignancies. METHODS: A retrospective analysis was performed to establish the safety and efficacy of cone-beam computed tomography (CBCT)-guided RFA in patients with metastatic colorectal cancer between 2016 and 2019, and the prognostic factors of local tumor control were assessed. RESULTS: A total of 31 patients with colorectal cancer underwent 48 sessions of lung RFA. The mean diameter of metastases targeted for RFA was 11 mm (range: 4-32), and the RFA was technically successful in 43 sessions (90%). There were 14 complications (29%), the majority of which required no intervention, with no cases of mortality. The median follow-up duration from RFA in the surviving 29 patients was 18.0 months. Only two patients (6%) died of disease progression, and the 3-year overall survival rate was 91% (95% CI: 83-99). Local tumor progression (LTP) of the RFA site was observed in 27%, and the LTP-free survival rates at 1 and 2 years were 81% (95% CI: 70-82) and 64% (95% CI: 50-77), respectively. Multivariate analysis showed that the progression of extra-RFA sites and the presence of extrapulmonary metastasis were independent prognostic factors significantly associated with LTP at RFA site. CONCLUSION: Lung RFA using CBCT guidance is a comparatively safe and effective option for the treatment of lung metastases from colorectal cancer. However, the control of extrapulmonary metastases should be accompanied by combined or sequential systemic treatment and local treatment.

Incidence and severity of Visually Induced motion Sickness during 3D laparoscopy In Operators who had No experience with it (VISION).

AIM: The aim of the study was to evaluate the incidence and severity of visually induced motion sickness (VIMS) during 3D laparoscopy, in operators without prior experience. MATERIAL AND METHODS: Design: A retrospective comparative study (Canadian Task Force classification II-2). Setting: A university hospital. Intervention: Gynecologic surgery. Main outcome measure: This is a prospective observational study, which enrolled 9 surgeons as participants. None of these surgeons had any prior experience with 3D laparoscopy. Each participant performed 10 consecutive cases of 3D laparoscopy in patients with benign or premalignant gynecological diseases. The primary outcome measure was the incidence and severity of VIMS, which was evaluated using the validated Simulator Sickness Questionnaire. Personal preferences, discomfort, and ease of 3D laparoscopy were also evaluated. RESULTS: Sixty-seven percent of surgeons experienced VIMS during their first 3D laparoscopy case. The incidence and severity of VIMS dramatically decreased from the second case onward. However, in some surgeons (22-44%), VIMS did not completely disappear until the tenth case. With respect to the discomfort using 3D laparoscopy, 84 self-reported responses after each surgery were "favor 3D laparoscopy," and "no" in 61 (72.6%) and 47 (55.9%) participants, respectively. Most participants found it easier to perform 3D laparoscopy than 2D laparoscopy. CONCLUSIONS: The occurrence of visually induced symptoms in susceptible individuals during 3D laparoscopy is high, particularly during their first case. This suggests the need for increasing surgeons' awareness regarding the possibility of discomfort.

Historical Perspectives of Korean Society for Thoracic and Cardiovascular Surgery: Inauguration and Activities of the Historical Records Preservation Committee.

The Korean Society for Thoracic and Cardiovascular Surgery (KTCVS) was founded in 1968 and celebrated the 50th anniversary of its founding in 2018. The launch of the KTCVS may seem somewhat recent, given that the American Association for Thoracic Surgery was founded in 1917. However, considering the circumstances of the Korean medical community after the Japanese occupation (1910-1945), World War II (1940-1945), and the Korean War (1950-1953), this apparent delay is understandable. Even before the foundation of the KTCVS, the early pioneers of thoracic and cardiovascular surgery promptly adopted medical technologies from more advanced countries such as the United States, and contributed significantly to both cardiac and thoracic surgery despite difficult circumstances. In 2012, before the 50th anniversary of the founding of the KTCVS, members shared the opinion that objective records of the activities of the early pioneers should be identified and preserved, and reacted positively towards the necessity for historians who would preserve such records. With this background, the Historical Records Preservation Committee of the KTCVS (hereinafter, referred to as 'the Committee') was launched. The Committee published a white paper on the history of thoracic and cardiovascular surgery in 2015 and held an exhibition of the achievements of the pioneers at the 50th anniversary of the founding of the KTCVS. The Committee also published a book entitled "The history of Korean thoracic surgery with photographs: celebrating the 50th anniversary of the society." The Committee will keep making efforts to find and preserve materials related to activities during the early development of thoracic and cardiovascular surgery in Korea.

The effect of intestinal permeability and endotoxemia on the prognosis of acute pancreatitis.

BACKGROUND/AIMS: Early intestinal mucosal damage plays an important role in severe acute pancreatitis (AP). Previous studies have shown that intestinal permeability (IP), serum endotoxin and cytokines contribute to the early intestinal barrier dysfunction in AP. This study explored the predictive capacity of IP, endotoxemia and cytokines as prognostic indicators in AP patients. METHODS: Eighty-seven AP patients were included in the study. The patients were classified into three groups according to the Balthazar computed tomography severity index (CTSI). We compared the biochemical parameters, including IP, serum endotoxin level and cytokine level among the three groups. The associations of IP with serum endotoxin, cytokines, CTSI, and other widely used biochemical parameters and scoring systems were also examined. RESULTS: IP, serum endotoxin, interleukin (IL-6) and tumor necrosis factor (TNF)-α had a positive correlation with the CTSI of AP. Endotoxin, IL-6, TNF-α, CTSI, the Ranson/APACHE II score, the duration of hospital stay, complications and death significantly affect IP in the AP patients. CONCLUSIONS: We believe that IP with subsidiary measurements of serum endotoxin, IL-6 and TNF-α may be reliable markers for predicting the prognosis of AP. Further studies that can restore and preserve gut barrier function in AP patients are warranted.

Transcatheter Embolization of Giant Pulmonary Arteriovenous Malformation with an Amplatzer Vascular Plug II.

Pulmonary arteriovenous malformation (PAVM) is a rare anomalous direct communication between the pulmonary artery and vein with a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. Although the past, surgical resection such as lobectomy was mostly used to treat PAVM, the recent development of endovascular treatment has made it a primary consideration to perform transcatheter embolization using coils or detachable balloons. We report a case of successful transcatheter embolization of giant PAVM with the second generation Amplatzer vascular plug II as a new self-expanding device.

Solitary Langerhans cell histiocytosis arising from sternum: a case report.

Langerhans cell histiocytosis (LCH) is a rare idiopathic benign disease characterized by proliferation of Langerhans cells, most commonly in the skull. In extremely rare cases, the tumor can occur in the sternum. A 4-year-old girl presented to our institution with a firm, nontender mass in her anterior chest that had indolently enlarged to approximately 2 cm in diameter over the previous several months. Computed tomography, magnetic resonance imaging, and F18-flurodeoxy-glucose positron emission tomography computed tomography were performed for preoperative diagnosis, but the findings were inconclusive. Therefore, we performed surgical excision under general anesthesia, followed by microscopic and immunohistochemical analysis of the excised specimen. The mass was eventually diagnosed as a LCH arising from the sternum. No postoperative oncological treatment was given, and follow-up has continued for 1 year until the time of writing without any tumor recurrence. To our knowledge, only 10 cases of LCH arising from the sternum have been reported in the medical literature. Among them, surgical approaches including curettage and partial sternotomy were performed in only 6 cases. Without exception, all patients experienced excellent clinical outcomes. Therefore, additional clinical experiences are required. No standard treatment of choice for this disease currently exists. In our experience, curettage of the involved soft tissue mass and bone followed by appropriate reconstruction of the defect is considered a good option for the treatment of solitary LCH of the sternum. In addition, LCH should be considered in the differential diagnoses when a sharp delineated osteolytic mass is detected in the sternum.

Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy.

Since the first implant of totally implantable venous access device (TIVAD), performed by Niederhuber and colleague in 1982, the systems have increasingly been used in the field of oncology. We analyzed the clinical reviews and complications of TIVAD in an effort to achieve optimal management. We retrospectively studied 442 cases with TIVAD device at our hospital and we report the results. Four hundred and forty-two TIVAD were placed in the right subclavian vein in 345 cases, the left subclavian vein in 93 cases, the right jugular vein in 2 cases, the left jugular vein in 1 case, and the right femoral vein in 1 case. The immediate complications were 28 cases in malposition of the catheter, 10 cases of arterial puncture, and 2 cases of pneumothorax. The late complications were 3 cases of pocket infection, 2 cases of catheter related to sepsis, 3 cases of catheter obstruction, 2 cases of SVC thrombosis, and 1 case of catheter fracture (pinch-off syndrome: Hinke grade 3). There were no other early or late complications. The low rate of complications in the study confirms the safety and convenience of using TIVAD in patients undergoing prolonged chemotherapy. Yet because infection, thrombosis and catheter fracture are the most common long-term complications of TIVAD, early diagnosis and management of these problems can prevent severe complications.

Venous distensibility as a key factor in the success of arteriovenous fistulas at the wrist.

BACKGROUND: The diameter of veins in the superficial forearm has been shown to correlate with risk for nonmaturation of newly created arteriovenous fistulas (AVFs). However, reported cut-off diameters are inconsistent. The purpose of our study was to assess the optimal diameter and distensibility of the radiocephalic vein at the wrist using the tourniquet method. METHODS: We selected 50 consecutive patients who received AVFs between June 2007 and July 2009. All patients underwent venography before surgery. Approximately 30 minutes after the first venography, the upper arm cuff was inflated to stop superficial venous return. After 1 minute, a second venography was performed, after which the diameters of the distended radiocephalic veins were measured. We used these data to determine the optimal size and distensibility of the radiocephalic vein for a successful AVF at the wrist. RESULTS: Participants consisted of 38 men and 12 women. We found no significant correlation between diabetes or hypertension and success of AVFs. We found that radiocephalic veins with diameters >3.25 mm after the tourniquet maneuver had a fourfold higher success rate compared with that of smaller veins, but this difference was not statistically significant (p = 0.09). We also found that the procedure success rate was significantly higher with radiocephalic veins whose diameters increased by >0.35 mm during venography (odds ratio = 7.422). CONCLUSION: For AVFs, it is important to use radiocephalic veins with a diameter of ≥3.25 mm after the tourniquet maneuver. In addition, AVF outcomes at the wrist are significantly better using radiocephalic veins that show an increase of >0.35 mm on venography.

Lemierre syndrome.

Lemierre syndrome is caused by acute oropharyngeal infections with secondary septic thrombophlebitis of the internal jugular vein and is characterized by frequent metastatic infections. A 56-year-old man presented with severe reddish inflammatory swelling of the right cervical soft tissue. Thrombophlebitis in the right internal jugular vein and multiple pulmonary embolisms were identified on neck and chest computed tomography (CT). He was treated with antibiotics and heparin for 4 weeks and then discharged without other complications.

A case of metachronous metastasis to the breast from non-small cell lung carcinoma.

Breast metastases from an extramammary primary tumor are very rare and the prognosis for such patients is generally poor. We report here on a case of a 42-year-old female with metastasis of non-small cell lung cancer to the breast, and she is now being followed up on an outpatient basis. In 2004, she presented with a solitary pulmonary nodule in the left lung, and this lesion had been noted to have gradually increased in size over time. The final pathological diagnosis was adenocarcinoma, and the diagnosis was made by performing percutaneous needle aspiration and lobectomy of the left upper lobe. Adjuvant chemotherapy and radiotherapy were given. Unfortunately, a nodule in the left breast was noted three years later, and metastatic non-small-cell lung cancer to the breast was diagnosed by excisional biopsy. Making the correct diagnosis to distinguish a primary breast carcinoma from a metastatic one is important, because the therapeutic plan and outcome for these two types of cancer are quite different.

Up-regulated claudin 7 expression in intestinal-type gastric carcinoma.

The disruption of tight junction protein expression in cancer might account for invasiveness, loss of cohesion, and lack of differentiation. Our cDNA array data indicated that claudin 7 was up-regulated in gastric carcinoma. We investigated the expression patterns and clinical implications of claudin 7 in gastric cancer. By immunohistochemical staining and Western blot, claudin 7 was significantly more often expressed in intestinal metaplasia, adenoma and cancer than in normal gastric epithelium. Twenty-seven (47.4%) of 57 normal gastric epithelium samples did not express claudin 7, but 50 (86.2%) of 58 intestinal metaplasia, 11 (91.7%) of 12 adenoma tissues, and 129 (82.7%) of 156 cancer samples did. Claudin 7 was more often unexpressed in diffuse type gastric cancer than in intestinal type. Only 13 (11.2%) of 116 intestinal type samples did not express claudin 7, but 14 (41.2%) of 34 diffuse type samples showed no expression. Compared to normal gastric epithelium, intestinal type gastric cancer significantly more often expressed claudin 7, but diffuse type did not. The expression pattern of claudin 7 did not change as cancer progressed. In this study we show that claudin 7 expression changed with the gastric carcinogenic process and that this is implicated in cancer characteristics.

Rare case of multiple pulmonary artery aneurysms with caval thrombosis--Hughes-Stovin syndrome.

Hughes and Stovin first reported a syndrome consisting of multiple pulmonary artery aneurysms and venous thrombosis in 1959. We encountered a 45-year-old man who had massive hemoptysis and leg swelling. The CT and angiography showed huge bilateral pulmonary artery aneurysms and inferior vena caval thrombosis. The bilateral lower lobe aneurysms were successfully treated with staged operations. The patient tolerated the procedures relatively well and was followed up by steroid therapy with a good response.

The effect of oral glutamine on 5-fluorouracil/leucovorin-induced mucositis/stomatitis assessed by intestinal permeability test.

BACKGROUND & AIMS: Systemic chemotherapy may damage gastrointestinal epithelium. Mucositis is associated with increased intestinal permeability (IP). It is known that IP test with chromium 51-ethylene diaminetetra-acetate (51Cr-EDTA) is a useful tool to assess the mucositis. Oral glutamine supplements (OGS) may have a role in the prevention of chemotherapy-induced mucositis/stomatitis. The aim of this study was to characterize the relationship between the urinary excretion of 51Cr-EDTA and the severity of mucositis, and the effect of OGS on 5-fluorouracil/leucovorin (FU/LV)-induced mucositis/stomatitis. METHODS: Fifty-one patients with advanced or metastatic cancer received FU/LV chemotherapy. The control group included 18 healthy volunteers. IP was assessed via the measurement of 51Cr-EDTA urinary excretion after oral challenge, on days 7 after the discontinuation of chemotherapy. Of the 51 patients, 22 patients received OGS (30 g/day) and 29 received only best supportive care (BSC). Glutamine supplementation continued for 15 days. It was initiated at least 3 days before the beginning of chemotherapy. Mucositis/stomatitis was graded according to version 3.0 of the Common Terminology Criteria for Adverse Events. RESULTS: In the chemotherapy group, the median (25 percentile, 75 percentile) IP test score was significantly higher than those of the control group [6.78% (4.63, 10.66) vs. 2.17% (1.38, 2.40), P<0.001]. The severity of stomatitis was significantly correlated with IP test scores (r=0.898, P<0.001). In the OGS group, the median IP test score was significantly lower than that of the BSC group [4.69% (3.10, 6.48) vs. 8.54% (6.48, 15.31), P<0.001]. A mucositis/stomatitis of grade 2-4 was observed in two patients of the OGS group (9%), and in 11 patients (38%) in the BSC group (P<0.001). CONCLUSIONS: The IP test may be a useful tool in the evaluation of mucositis/stomatitis. OGS may exert a protective effect on FU/LV-induced mucositis/stomatitis. Further studies, however, will be necessary to define the role of glutamine supplementation in FU/LV-induced mucositis/stomatitis.

Enhancement of antitumor immunity of dendritic cells pulsed with heat-treated tumor lysate in murine pancreatic cancer.

Cancer vaccines using dendritic cells (DCs) have been shown to induce antitumor immunity and have recently been applied to non-immunogenic cancers, such as pancreatic cancer. In this study, we utilized DCs loaded with heat-treated tumor lysate (HTL-DC) as a vaccine in order to stimulate antitumor immunity in a murine pancreatic cancer model and compared them to DCs loaded with tumor lysate (TL-DC). The poorly immunogenic mouse ductal pancreatic cancer cell line PANC02 with syngeneic mouse strain C57BL/6 was used as a model. Inducible heat shock proteins (HSPs) were significantly increased in HTL (HSP70 and HSP90). Tumor size measurements indicated that HTL-DC induced stronger tumor suppression than unpulsed DC or TL-DC (43% reduction in tumor volume compared to control group). T cell proliferation assay and IFN-gamma ELISPOT assay showed that T cell activation increased in the following order: DC