Basal segment deep wedge resection for lung cancer with pulmonary fibrosis.

Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is among the most fatal postoperative complications of lung resection in patients with IPF. Non-small-cell lung cancer (NSCLC) with IPF exhibits basal segment dominance. Treatment options for these lesions include lobectomy or basal segment segmentectomies. However, these procedures potentially increase risks of AE due to surgical stress including prolonged operative time and loss of pulmonary function. Therefore, as an alternative to these procedures, we developed a simple and practical deep wedge resection technique for basal segments. Our technique is minimally invasive and quick and simple approach in patients with NSCLC and IPF.

[Mediastinal Giant Vagal Nerve Schwannoma;Report of a Case].

A 73-year-old man visited his family doctor with complaints of cough and breathlessness. Right pleural effusion was detected by chest X-ray. Computed tomography(CT) showed a huge mass 13×11 cm in the right mediastinum along with right pleural effusion and atelectasis of the right middle and lower lobes. Surgery was performed 4 days after admission. Although the tumor was huge, it could be successfully removed. The symptoms improved and the patient was discharged after 10 days of surgery. Pathological examination revealed vagal nerve schwannoma with no malignant features.

Ultrasound cardiography examinations detect victims' long-term realized and potential consequences after major disasters: a case-control study.

BACKGROUND: An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster. METHODS: The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire. RESULTS: Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period-from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p < 0.0001). CONCLUSIONS: It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster. TRIAL REGISTRATION: UMIN; ID000029802. R000034050 . 2 November 2017.

[Second Pneumothorax in an Ehlers-Danlos Syndrome Patient Initially Treated by Bullaectomy Twenty-two Years Ago].

A 2nd pneumothorax developed in a 40-years-old man after his 1st bilateral pneumothoraces were successfully treated by bullaectomies 22 years ago. For the past 10 years, he has suffered major complications such as repeated bleeding into the digestive tract due to vascular-type Ehlers-Danlos syndrome (vEDS). Although preoperative computed tomography demonstrated multiple bullae at the apex of the right lung, any abnormal findings suggesting tissue fragility was not found. At surgery, visceral pleura of the right lung had an almost normal appearance through a thoracoscope. However, we found that gentle touch with soft surgical equipment resulted in serious pleural damage leading to new air leakage. Our case suggests a progressive fragility of the lung in a vEDS patient, and a less invasive pleural covering technique would therefore be preferable when major complications become evident, despite previous successful bullaectomy.

The utility of on-site ultrasound screening in population at high risk for deep venous thrombosis in temporary housing after the great East Japan Earthquake.

BACKGROUND: To evaluate the diagnostic performance of ultrasonography for screening of a population at risk for deep vein thrombosis (DVT) in a post-disaster setting. METHODS: Ultrasonography was applied as a screening technique to the residents of a temporary housing facility who were displaced following the Great East Japan Earthquake. Thirty DVT screening sessions were held from April 2013 to June 2015. Individuals were invited to participate if they were identified as "high risk" for DVT, defined as those with low activity levels, a history of lower limb trauma, baseline lower limb pain or swelling, a cancer-bearing status, or a history of venous thromboembolic event. Ultrasonographic examinations were performed from the calf to the popliteal veins using portable devices. RESULTS: Of the 3,316 subjects screened (682 men and 2,634 women) with a mean age of 71 ± 9.7 years, DVT was diagnosed in 382 (11.5%). DVT was more likely in older, symptomatic, or female patients with a history of venous thromboembolism and attempting to perform daily exercise. The rate of DVT diagnosis increased from 9.9% in 2013 to 13.5% in 2015. CONCLUSIONS: Ultrasonography is efficient for screening at-risk populations in challenging settings. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:566-574, 2017.

Two Cases of Tsunami Dust Pneumonia: Organizing Pneumonia Caused by the Inhalation of Dried Tsunami Sludge after the 2011 Great East Japan Earthquake.

We report two cases of organizing pneumonia (OP) secondary to the inhalation of the dried tsunami sludge which formed during the 2011 Great East Japan Earthquake and the consequent tsunami. After the disaster, both of these patients had been engaged in the restoration work. About half a month later, they developed shortness of breath and pulmonary infiltrates. These patients were diagnosed with interstitial pneumonia. Their biopsy specimens revealed multifocal peribronchiolitis and OP. An electron probe microanalysis of these specimens demonstrated the presence of elements from the earth's crust in the inflammatory lesions. These two cases indicate that exposure to dried tsunami sludge can cause OP.

One-year overview of deep vein thrombosis prevalence in the ishinomaki area since the great East Japan earthquake.

After the Great East-Japan Earthquake, the prevalence of deep vein thrombosis (DVT) in disaster shelters in Ishinomaki (Pacific coast, Miyagi, Japan) was found much higher than that ever reported in Japan. In Ishinomaki, twelve patients were found to have pulmonary thromboembolism for one month since the earthquake and DVT was found in 10 of those patients. The calf DVT was examined using ultrasonography in the shelters (from March to July 2011) and in temporary emergency housings (from August to December 2011). Calf DVT was found in 190 of 701 evacuees. DVT prevalence was higher in the tsunami-flooded shelters (34.2%) than in that in the non-flooded shelters (19.1%). This indicated that deteriorated and crowded condition in the tsunami-flooded shelters might induce thrombogenesis in calf veins. Therefore, evacuees were recommended to leave tsunami-flooded areas. DVT prevalence in the shelters was gradually reduced, however, that was still higher in the temporary emergency housings (8.9%) than in the non-disaster area in Japan (2.2% in Yokohama city). The risk of calf DVT in the temporary emergency housings was increased because of reduced blood flow in the calf veins caused by immobility. The residents of the housings were required to be physically active to avoid calf DVT. (English translation of Jpn J Phlebol 2013; 24: 380-384).

The clinical utility of makeshift beds in disaster shelters.

OBJECTIVE: Strong earthquakes have been reported to increase the incidence of diseases. One reason for these increases may be the stress from the poor living environment for evacuees in disaster shelters. To reduce stress, makeshift cardboard beds were introduced in shelters in the Ishinomaki region, one of the areas heavily damaged by the Great East Japan Earthquake, 4 months after the earthquake. The study was performed to determine whether use of the beds offered a reduction in the disease burden. METHODS: Blood pressure and blood D-dimer values, often used as diagnostic tests for venous thrombosis, were checked. The timed Up & Go (TUG) test, which assesses functional mobility; a questionnaire survey about symptoms (cough, insomnia, and lumbago); and an SF-8 health survey, a health-related quality of life survey, were also administered before and 1 month after introducing the beds. RESULTS: Blood pressure measurements, TUG test results, and questionnaire survey scores improved significantly 1 month after the introduction of the beds. Also, evacuees with higher blood D-dimer values tended to show improvement, suggesting that the beds may have had a good effect on persons with underlying venous thrombotic disorders. CONCLUSION: Makeshift beds of cardboard could be very useful in disaster shelters.

Chest injuries and the 2011 Great East Japan Earthquake.

BACKGROUND: Chest injuries caused during a major earthquake remain unclear. We have described profiles of patients with chest injuries who were diagnosed and treated at the area that was most affected by the Great East Japan Earthquake in 2011. METHODS: We retrospectively reviewed medical records of 3938 patients who were transferred to the Japanese Red Cross Ishinomaki Hospital during the first week after the earthquake (March 11-17). In total, 77 patients were declared dead on arrival at the hospital. Of the remaining 3861 patients, 42 (1.1%) sustained chest injuries. Diagnosis of the chest injury was based on results of physical examination, chest radiography, and computed tomography. RESULTS: Chest injury was diagnosed in 42 patients, including 22 men and 20 women (age range, 21-99 years). The most common cause of injury was tsunami (n=21), followed by falls (n=9), and traffic accidents (n=1), although this information was missing in 11 cases. The most common type of chest injury was superficial trauma such as laceration and contusion (n=37). Only 5 patients had rib fractures with intrathoracic damages such as pneumothorax (n=3), hemothorax (n=1), and aspiration (n=1). CONCLUSIONS: The number of patients with chest injury was surprisingly small. Most patients did not require hospitalization. The small number of survivors with serious chest injuries can most likely be explained by the tsunami caused by the earthquake.

Impact of a large-scale natural disaster on patients with chronic obstructive pulmonary disease: the aftermath of the 2011 Great East Japan Earthquake.

BACKGROUND: A large-scale natural disaster may exacerbate chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD). The aftermath of a natural disaster can include poor access to medication, medical equipment, and medical supplies. Little is known about the impact on patients with COPD. METHODS: A retrospective cohort study was conducted at a regional medical center in Ishinomaki, the area affected most severely by the Great East Japan Earthquake in 2011. The study was performed 6 months after the disaster. The characteristics, clinical courses, and outcomes of COPD patients hospitalized after emergency visits during the study period were investigated and compared. RESULTS: One hundred patients (112 episodes) were identified. Within a few days after the disaster, patients undergoing oxygen therapy at home came to the hospital to receive oxygen. In the subacute phase (from the third to the fifth week), the number of hospitalizations due to COPD exacerbations was significantly increased compared to the numbers observed before the earthquake (p<0.05). On admission, COPD patients reported significantly reduced participation in the activities of daily living (ADLs) after as compared to before the disaster. The incidence of cases of exacerbated COPD normalized 6 weeks after the earthquake. CONCLUSIONS: The large-scale natural disaster that hit Japan in 2011 had a serious negative impact on the clinical outcomes of COPD patients in the disaster-affected area.

High prevalence of deep vein thrombosis in tsunami-flooded shelters established after the great East-Japan earthquake.

High prevalence of deep vein thrombosis (DVT) in disaster shelters has been reported in the aftermath of earthquakes in Japan. Calf DVT was examined using sonography in the shelters after the Great East Japan earthquake on March 11, 2011. By the end of July 2011, 701 out of 8,630 evacuees suspected with calf DVT, judged by inspections or medical interviews, were examined in 32 shelters, and 190 evacuees were confirmed to have calf DVT. The prevalence of DVT was 2.20%, which was 200 times higher than the usual incidence in Japan. The DVT prevalence seemed to decrease with time. By the end of May, a significantly higher prevalence of DVT was found in tsunami-flooded shelters (109 of 3,871 evacuees; 2.82%) than in non-flooded shelters (53 of 3,155 evacuees; 1.68%). After June, its prevalence was still higher (18/541; 3.33%) in tsunami-flooded shelters than in non-flooded shelters (10/1063; 0.94%). The cause of the high prevalence of DVT was supposed to be dehydration due to the delay in supplying drinking water, vomiting, and diarrhea experienced by the evacuees because of a shortage of clean water to wash their hands. Dehydration was especially noticed in women because they restricted themselves of water intake to avoid using unsanitary toilet facilities. Moreover, crowded shelters restricted the mobility of elderly people, which would exacerbate the prevalence of DVT. Those deteriorated and crowded shelters were observed in tsunami-flooded areas. Therefore, long-term shelters should not be set up in flooded areas after tsunami.

Delayed cardiac rupture occurring two months after blunt chest trauma.

We describe a rare case of successful repair of delayed cardiac rupture due to blunt chest trauma; the cardiac rupture occurred 74 days after the trauma. A 75-year-old woman with a history of blunt chest trauma that caused multiple rib fractures underwent an emergent thoracotomy due to left hemothorax. A coin-sized pericardial defect and cardiac rupture on the left ventricle was found to be close to a fractured rib, which was thought to have damaged the myocardium and thus induced time-dependent myocardial degeneration. The cardiac rupture and the pericardial defect did not induce life-threatening cardiac tamponade; however, the cardiac rupture did induce hemothorax, which could be successfully treated.

[Uncomplicated covering technique for preventing the recurrence in the thoracoscopic surgery for pneumothorax].

Reinforcement of the visceral pleura along the stapled line and prevention of lung-chest wall adhesion is supposed to decrease the recurrence rate of video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. Covering over the stapled line with an absorbable mesh; polyglycolic acid and regenerative oxidized cellulose mesh, and a fibrin glue is recognized useful for that, although, it tends to be troublesome in VATS procedure. In this article, we present the knack of the covering method: (1) installation of the absorbable mesh on the visceral pleura; a folded absorbable mesh is hold with the endoscopic autosuture or grasping foreceps and placed on the pleura without curling up; (2) installation of a fibrin glue over the pleura and the mesh using a rubbing device (U-rod); each of the fibrinogen solution and the thrombin solution are applied and rubbed on the pleura and the mesh. Surgeons can perform them without any complicated technique.

Bone marrow-derived cells contribute to lung regeneration after elastase-induced pulmonary emphysema.

All-trans retinoic acid (ATRA) is known to reverse the anatomic and physiologic signs of pulmonary emphysema. However, the origin of the progenitor cells involved in this lung regeneration remains unclear. Recently, it was shown that bone marrow could be the source of progenitor cells for several cell types. Mice with elastase-induced emphysema were treated with ATRA, granulocyte colony-stimulating factor (G-CSF), or a combination of both. ATRA or G-CSF promoted lung regeneration and increased bone marrow-derived cell (BMC) numbers in alveoli. Combined treatment of both had an additive effect, which indicated that BMC mobilization might be important in lung regeneration.

Bone marrow-derived progenitor cells are important for lung repair after lipopolysaccharide-induced lung injury.

Tissue repair often occurs in organs damaged by an inflammatory response. Inflammatory stimuli induce a rapid and massive release of inflammatory cells including neutrophils from the bone marrow. Recently, many studies suggested that bone marrow cells have the potential to differentiate into a variety of cell types. However, whether inflammatory stimuli induce release of bone marrow-derived progenitor cells (BMPCs), or how much impact the suppression of BMPCs has on the injured organ is not clear. Here we show that LPS, a component of Gram-negative bacterial cell walls, in the lung airways, induces a rapid mobilization of BMPCs into the circulation in mice. BMPCs accumulate within the inflammatory site and differentiate to become endothelial and epithelial cells. Moreover, the suppression of BMPCs by sublethal irradiation before intrapulmonary LPS leads to disruption of tissue structure and emphysema-like changes. Reconstitution of the bone marrow prevents these changes. These data suggest that BMPCs are important and required for lung repair after LPS-induced lung injury.

Effects of rewarming on nuclear factor-kappaB and interleukin 8 expression in cold-preserved alveolar epithelial cells.

BACKGROUND: Nuclear factor-kappaB (NF-kappaB) and interleukin (IL)-8 play important roles in the pathophysiology of acute lung injury after lung transplantation. Because alveolar epithelium is one of the most important sites at which IL-8 production takes place after reperfusion of donor lungs, we examined the effects of cold/rewarming on NF-kappaB and IL-8 expression in alveolar epithelial cells. METHODS: A549 cells were preserved at 4 degrees C for 5 hr and then rewarmed for up to 20 hr. NF-kappaB was analyzed by electrophoretic mobility shift assay. IL-8 mRNA expression was examined by reverse transcription-polymerase chain reaction. IL-8 concentration in the cell culture medium after rewarming was measured by enzyme-linked immunosorbent assay. RESULTS: NF-kappaB was increased in the nuclear extracts as early as 30 min after rewarming. There was a marked increase in the IL-8 mRNA expression at 1 and 3 hr after rewarming. IL-8 concentration in the cell culture medium was progressively increased during 20 hr following rewarming. The cell culture medium inhibited apoptosis of neutrophils significantly. The cold/rewarming-induced IL-8 production was reduced to approximately 50% by introducing an antisense oligonucleotide for the p65 subunit of NF-kappaB and by treatment with N-acetyl-leucinyl-leucinyl-norleucinal and pyrrolidine dithiocarbamate. The effect of dexamethasone treatment was dose dependent (reduced to approximately 30% at 10-5 M dexamethasone). CONCLUSIONS: Our results indicate that rewarming of cold-preserved alveolar epithelial cells itself may be an important initiator of the inflammatory cascades, including NF-kappaB activation and IL-8 release. Inhibition of NF-kappaB would be worth trying to control unnecessary IL-8 production and the inflammatory response in the donor lungs.