Effect of Rehabilitation Nutrition on a Post-Acute Severe COVID-19 Patient: A Case Report.

Coronavirus disease 2019 (COVID-19) may lead to post-acute physical function deterioration due to intensive-care-unit-acquired weakness-related sarcopenia and dyspnea. Limited reports have examined the effects of rehabilitation and nutritional therapy on patients with post-acute COVID-19. We present the case of a 67-year-old man, who was admitted for the treatment of post-acute severe COVID-19, who benefited from rehabilitation nutrition. When the patient's condition stabilized, sarcopenia and malnutrition were observed, and rehabilitation nutrition was implemented. The physical therapist implemented a program focused mainly on resistance training and aerobic exercise, and the dietitian provided oral nutritional supplements and hospital food that met the patient's energy and protein intake requirements. Comparing the initial evaluations with those at discharge, factors affecting nutritional status, such as body mass index and skeletal muscle mass index, and physical functions, such as grip strength and walking speed, and dyspnea, had improved. The patient was discharged and returned to work. This case suggests improvements in the nutritional status and physical functions of post-acute severe COVID-19 patients by interventions following rehabilitation nutrition.

Effects of Early Physical Therapist-supervised Walking on Clinical Outcomes after Liver Resection: Propensity Score Matching Analysis.

OBJECTIVE: The study aimed to demonstrate the significance of early postoperative physical therapy interventions on clinical outcomes by determining the influence of the distance walked under the supervision of a physical therapist in the early postoperative period after liver cancer. METHODS: All consecutive patients who underwent surgery for liver cancer between April 2018 and March 2020 were eligible for enrollment in the study. The total walking distance during physical therapy till the third postoperative day was examined. The clinical outcomes comprised duration of postoperative hospital stay, time to independent walking, and occurrence of postoperative complications. For data analysis, the patients were divided into two groups: those who walked more than the median total distance (the long-distance group) and those who walked less than the median distance (the short-distance group). We used propensity score matching to match the background characteristics between the groups. RESULTS: Of the 65 patients who were eligible, 14 patients were included in the two groups each, after matching. The long-distance walking group had a significantly shorter hospital stay (9.0 days vs. 11.0 days, p=0.008) and a shorter time to independent walking (3.5 days vs. 7.5 days, p=0.019) than the short-distance walking group. There were no significant differences in postoperative complications between the two groups (7.1% vs. 42.8%, p=0.08). CONCLUSION: In the early postoperative period after liver cancer surgery, increasing the walking distance under the supervision of a physical therapist is important for improving clinical outcomes. Further prospective studies are needed to confirm the findings of this study.

Effect of Rehabilitation Nutrition Care Process on Physical Function in Lung Cancer Cachexia: A Case Report.

OBJECTIVES: Patients with cancer cachexia have poor adherence to treatment, which affects their prognosis. Currently, there are many studies on the effects of rehabilitation on cancer cachexia, but there is a lack of evidence on the effects of nutrition therapy alone or in combination with rehabilitation and nutrition therapy. This article describes a case in which rehabilitation nutrition care process was effective in a patient with lung cancer who developed cancer cachexia. METHODS: A 68-year-old woman was hospitalized for treatment of lung adenocarcinoma. The patient had moderate malnutrition, sarcopenia, and cachexia at the time of admission, so the authors intervened according to rehabilitation nutrition care process. The physiotherapist mainly prescribed resistance training and aerobic exercise, 40-60 minutes a day, 5-6 days a week. And the dietitian provided oral nutritional supplements (100 kcal, branched-chain amino acid: 3.0 g) in addition to hospital food and adjusted the patient's energy intake to 26.96-33.05 kcal/kg/day and protein intake to 1.07-1.14 g/kg/day. OUTCOMES: Comparing the initial evaluation with the discharge, nutritional status, such as body mass index and skeletal muscle mass, and physical functions, such as maximum grip strength, gait speed, and functional independence measure (motor items), were improved. CONCLUSIONS: Rehabilitation nutrition care process-based interventions may improve nutritional status and physical functions more than exercise therapy alone in patients with lung cancer cachexia.

Thoracoscopic anatomic pulmonary resection for locally advanced non-small cell lung cancer.

BACKGROUND: The safety and feasibility of thoracoscopic lobectomy for locally advanced lung cancer remain controversial. METHODS: Between April 2002 and April 2011, we retrospectively reviewed 100 consecutive patients who underwent anatomic pulmonary resection for preoperative stage II or greater non-small cell lung cancer at a single institution. After excluding 16 patients undergoing planned thoracotomy and 8 patients with preoperative stage IV disease, the remaining 76 patients who underwent thoracoscopic surgery were divided chronologically into three groups and analyzed. RESULTS: Thoracoscopic anatomic pulmonary resection was successfully performed in 74 patients (97.4%). There were 32 complications in 27 patients (35.5%), and 2 patients (2.6%) had grade 3 or higher complications. The operative, perioperative (30-day), and hospital mortality were 0%, 0%, and 2.6%, respectively. A significantly decreased operation time, a lower amount of blood loss, and increased numbers of bronchoplasty and bronchial coverage were seen, although there were no significant differences in the patient characteristics or other outcomes among the three groups. At a mean follow-up time of 40 months, the overall 3-year survival rates for pathologic stages I (n = 12), II (n = 27), III (n = 33), and IV (n = 4) were 100%, 64.2%, 36.2%, and 25.0%, respectively. CONCLUSIONS: Thoracoscopic anatomic pulmonary resection is feasible, with acceptable morbidity and mortality rates, as well as favorable oncologic outcomes, in selected patients with locally advanced non-small cell lung cancer. The learning curve for this procedure appears to be overcome after 25 consecutive patients.

Long-term survivor of primary anorectal malignant melanoma by a multi-disciplinary approach.

Anorectal malignant melanoma tends to show an aggressive biological behaviour. Therefore, the 5-year survival rate is limited. We herein present a successful case of a super-long-term survivor (20 years) who underwent multi-disciplinary treatment. The present case suggests that a multi-disciplinary approach may be beneficial for patients with thick and extensively sized lesions after radical resection for primary anorectal malignant melanoma.

Association between lymphangiogenesis-/micrometastasis- and adhesion-related molecules in resected stage I NSCLC.

BACKGROUND: The purpose of this study was to clarify the role and clinical significance of lymphangiogenesis/micrometastases and adhesion molecules in resected stage I non-small cell lung cancer (NSCLC). METHODS: Immunohistochemical (IHC) staining was used to analyze the protein expression of vascular endothelial growth factor-C (VEGF-C), VEGF, E-cadherin, alpha-catenin, beta-catenin, and gamma-catenin in paraffin-embedded tumor samples from 117 well-characterized stage I NSCLC patients and to compare the protein expression, clinical variables and survival outcome. As a micrometastatic parameter in lymph nodes (LNs), cytokeratin (CK) staining was performed. RESULTS: The positive expression of VEGF-C and VEGF were detected in 54 (48.7%) and 86 (73.5%), respectively. We identified micrometastatic tumor cells in pathological N0 LNs in 34 (29.1%) of 117 patients. E-cadherin, alpha-catenin, beta-catenin, and gamma-catenin were identified in 70 (59.8%), 41 (35.0%), 83 (70.9%), and 61 (52.1%) specimens, respectively. The VEGF-C expression was found more frequently in squamous cell carcinoma (SQ) and in the tumors with negative expression of beta-catenin than counter features. The VEGF expression was found more frequently in the tumors with a negative expression of E-cadherin. Micrometastasis was found more frequently in a pathological T2 status and in the tumors with a negative expression of alpha-catenin. Beta-catenin and gamma-catenin expressions were found less and more frequently in SQ, respectively. A univariate and multivariate survival analysis demonstrated that old age, pathological T2 status, and micrometastasis were independently associated with an increased risk of poor survival in the patients who underwent a surgical resection of stage I NSCLC. CONCLUSIONS: Complicated relationships exist between lymphangiogenesis/micrometastases and adhesion molecules with a specific histology. The detection of lymph nodal micrometastasis by CK may therefore be a useful marker for predicting a poor prognosis in patients who undergo a complete resection of stage I NSCLC.

Video-assisted thoracic surgery lobectomy for non-small cell lung cancer in patients with a Charlson comorbidity index score of two or more.

INTRODUCTION: We evaluated the feasibility and safety of the video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) in patients with comorbidity. METHODS: Between April 2000 and December 2006, a prospective database of 58 consecutive patients undergoing a VATS lobectomy for NSCLC, who had a Charlson comorbidity index score of 2 or more, was retrospectively analyzed. The demographic, perioperative, histopathologic, and outcome variables, including the recurrence and survival, were assessed. RESULTS: The VATS lobectomy was successfully performed in 57 patients (16 women and 41 men; median age, 70 years). Twenty-three patients (40.4%) were aged 75 years or older. The total score of the Charlson comorbidity index was as follows: 2 in 26 patients, 3 in 13 patients, 4 in 12 patients, 5 in five patients, and 6 in one patient. None of the patients required a blood transfusion during surgery or during the postoperative course. We observed no intraoperative or in-hospital deaths, and no complications occurred in the 45 patients (78.9%). At a median follow-up of 34 months, a recurrence was observed in five patients who had advanced stages: a local recurrence in one and a distant recurrence in four. The overall 5-year survival rates for postoperative stage IA (n = 25) and IB (n = 16) were 100% and 94%, respectively. CONCLUSIONS: We believe that a VATS lobectomy is a feasible and safe procedure for NSCLC in patients with comorbidity because this modality demonstrates an acceptable morbidity and a favorable oncologic outcome.

A prospective study of the association between drainage volume within 24 hours after thoracoscopic lobectomy and postoperative morbidity.

OBJECTIVES: We prospectively analyzed the association between drainage volume and development of complications to clarify the safety of early removal of chest tube after thoracoscopic lobectomy. METHODS: Between November 2001 and October 2007, 136 patients with suspected or histologically documented lung cancer were enrolled. Patients with no air leak and increased drainage underwent removal of the chest tube on the day after thoracoscopic lobectomy independent of the drainage volume. Patients were classified into three groups as tertiles according to the drainage volume. Demographic and perioperative variables were compared among the three groups. Age-sex adjusted odds ratios of the clinical variables associated with development of complications were estimated. In addition, the odds ratios of the drainage volume for development of complications were estimated after adjusting for potentially important factors. RESULTS: One hundred patients underwent early removal of the chest tube. Almost all demographic and perioperative variables showed no differences among the three groups (0-289 mL, n = 33; 290-399 mL, n = 33; and >or=400 mL, n = 34). Tumors in a lower lobe, preoperative stage II or higher, 5 or more anatomic segments resected, and advanced disease were all factors that were associated with higher odds ratios for complications. The drainage volume was not associated with an increased morbidity, even after adjusting for these factors. CONCLUSIONS: Early removal of chest tube on the day after thoracoscopic lobectomy, independently of the drainage volume, appears to be safe in well-selected patients.

Initial experience of video-assisted thoracic surgery lobectomy with partial removal of the pulmonary artery.

A lobectomy with a resection of the pulmonary artery is less invasive than a pneumonectomy. However, it seems to be extremely difficult to perform this technique using video-assisted thoracic surgery with technical limitations because this technique is associated with an increased operative risk even in an open thoracotomy. Between April 2002 and December 2006, a curative video-assisted thoracic surgery lobectomy including a mediastinal lymphadenectomy was performed in 121 patients with primary non-small cell lung cancer. Five of those patients underwent a thoracoscopic lobectomy with the partial removal and reconstruction of the pulmonary artery. The causes of the pulmonary artery resection included two direct invasions of the artery, two invasions of the arterial branch, and one calcified lymphadenopathy involving the branch. No patients required a blood transfusion. No complications attributable to the technique or mortality were seen. No patients showed an abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. A video-assisted thoracic surgery lobectomy including a partial resection and reconstruction of the pulmonary artery is a complex procedure for patients with non-small cell lung cancer. It is feasible when all associated technical issues are properly addressed.

Primary pulmonary collision cancer consisting of large cell carcinoma and adenocarcinoma.

A case of pulmonary collision tumor is herein reported. An abnormal shadow was discovered in the right lung of a 53-year-old man. A right upper lobectomy with a mediastinal lymph node dissection was performed. Based on the findings of a postoperative pathologic examination, this tumor was considered to be a collision tumor of large cell carcinoma and adenocarcinoma, as the distribution of each tumor was clearly separated. This case is the first report of a primary pulmonary collision tumor consisting of large cell carcinoma and adenocarcinoma.

Survival and prognostic factors of surgically resected T4 non-small cell lung cancer.

BACKGROUND: Category T4 nonsmall cell lung cancer (NSCLC) encompasses heterogenous subgroups. We retrospectively analyzed the survival of patients with surgically resected T4 NSCLC to evaluate the evidence for prognostic implications according to the subgroups of T4 category, nodal status, and resection completeness. METHODS: Seventy-six patients with T4N0-2M0 NSCLC were divided into three subgroups within the T4 category: 24 patients with the tumor invading the mediastinal organs (mediastinal group), 16 with a malignant pleural effusion or dissemination (pleural group), and 36 with satellite tumor nodules within the ipsilateral primary tumor lobe (satellite group). Complete resection was possible in 47 patients (61.8%). The pathologic N statuses were N0 in 28, N1 in 13, and N2 in 35 patients. RESULTS: The overall survival of the 76 patients was 19.1% at 5 years. The overall 5-year survivals according to the three subgroups of the T4 category were as follows: mediastinal group, 18.2%; pleural group, 0%; and satellite group, 26.7% (mediastinal/satellite versus pleural, p = 0.037). Factors significantly influencing the overall 5-year survival were the pathologic N status (N2 versus N0-1, p = 0.022) and the completeness of resection (complete versus incomplete, p = 0.0001). A multivariate survival analysis demonstrated that the pathologic N status and the completeness of resection were significant independent predictors of a poorer prognosis even after adjusting for the subgroup of the T4 category. CONCLUSIONS: Resectable T4N0-1 NSCLC that is not due to pleural disease deserves consideration of aggressive surgical resection with expected 5-year survival of about 20%.

Pleomorphic carcinoma: report of a case with massive pleural effusion and asbestos particles.

Pleomorphic (spindle/giant cell) carcinoma (PC) is one subset of large cell carcinoma. It is well known that PC patients have a poor survival rate. This report describes a 68-year-old man with PC. The patient's tumor had a massive pleural effusion. A left lower lobectomy and partial resection of the left diaphragm, peritoneum, and parietal pleura were performed to remove the tumor. Numerous asbestos particles were found in the left lower lobe. This is the first reported case of PC which may have been caused by asbestos particles. Further investigation is needed into whether asbestos exposure causes PC.

A case-case study comparing the usefulness of serum trace elements (Cu, Zn and Se) and tumor markers (CEA, SCC and SLX) in non-small cell lung cancer patients.

UNLABELLED: Serum copper (Cu), zinc (Zn) the Cu/Zn ratio (Cu/Zn) and selenium (Se) were evaluated in 84 patients with non-small cell lung cancer (NSCLC) before surgery. Serum carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and sialyl Lewis X-i antigen (SLX) levels were also determined in the same cases. The cut-off values of Cu, Zn and Se were established to create two categories with equal numbers of patients. We investigated the clinical and prognostic usefulness of assays of serum trace elements (Cu, Zn, Cu/Zn and Se) and compared levels of serum trace elements and serum tumor markers (CEA, SCC and SLX) in NSCLC patients. Furthermore, we evaluated the usefulness of serum trace elements, when compared with tumor markers, in assessing prognosis for NSCLC. IN CONCLUSION: (1) a preoperative increase in Cu/Zn level predicted tumor progression more effectively than changes in Cu or Zn levels; (2) Se levels seemed to vary with age, but there was no relationship between Se level and disease stage; (3) the measurement of Cu/Zn was useful for assessing both prognosis and extent of the disease in NSCLC patients, similar to the measurement of serum tumor markers such as CEA; and (4) the measurement of the Cu/Zn had prognostic significance, but was inferior to disease stage in predicting outcome. Cu and Zn in serum are storable and the determination of Cu/Zn level is so simple and inexpensive that it can be helpful in determining clinical stages and predicting the prognoses of NSCLC patients.

Feasibility of induction chemotherapy using bronchial arterial infusion for locally advanced non-small cell lung cancer: a pilot study.

PURPOSE: We examined the feasibility and effectiveness of bronchial arterial infusion (BAI) as induction chemotherapy before surgery for locally advanced non-small cell lung cancer (NSCLC). METHODS: Eighteen patients with locally advanced NSCLC were given BAI consisting of cis-diamminedichloroplatinum (CDDP) (50-100 mg/m(2)) as induction chemotherapy before surgery (induction BAI). Six patients with clinical stage IIIA cancer had bulky N2 metastatic lymph nodes, and 12 patients with clinical stage IIIB cancer had T4 disease. RESULTS: Of the 18 patients, 12 (67%) showed a partial response to the BAI therapy. Standard pulmonary resection was performed in 5 patients, pulmonary resection with the combined resection of adjacent organs was performed in 10 patients, and pulmonary resection with carinal resection and reconstruction was performed in 3 patients. Complete resection was possible in 14 patients (78%). There were no serious BAI therapy-related complications or postoperative deaths. The 5-year survival rate of the 18 patients was 35.7% and the median survival time (MST) was 19.4 months. Survival was better when complete resection was achieved after the induction BAI, especially in patients with stage IIIB (T4) disease. CONCLUSION: Based on our preliminary findings, BAI with CDDP as induction chemotherapy is feasible and may be an effective therapeutic modality for locally advanced NSCLC.

[Pulmonary resection for metastatic colorectal cancer].

We analyzed the outcome of 30 patients who underwent surgery (40 operations) for pulmonary metastases of colorectal cancer. Overall 5-year survival rate was 56%. There were no significant differences in survivals 5 years after the first surgery on the basis of potential prognostic factors: disease free interval, number of pulmonary metastases and size of metastatic lesion. Three patients with recurrent pulmonary metastases after the first resection underwent repeated resections and are alive 23, 58 and 62 months after the first pulmonary metastasectomy, respectively. Pulmonary resection for metastases from colorectal cancer prolonged the survival of patients, even those with bilateral lesions or recurrent metastases. These results confirm that pulmonary resection for metastatic colorectal cancer is a potentially curative therapy.

[Two cases of synchronous superficial double cancers in the esophagus and stomach].

Two surgical cases of synchronous double esophageal and gastric cancer, both of which revealed a superficial type were investigated. The first case was a 58 years old man, who was found to have an abnormal gastric shadow on mass screening. Gastrointestinal examination revealed a synchronous double cancer of the esophagus (Mt-Lt, m) and stomach (L, m). An endoscopic mucosal resection was performed on the gastric cancer and after 3 weeks a blunt dissection on the esophageal cancer was performed and the gastric tube was reconstructed. The second case was a 65 years old man, who was found to have an ulcerative esophageal tumor (Ut, type 2) and a gastric tumor (M, 0-II c) at the anterior wall of the upper body on gastrointestinal examination for a complaint of hematemesis. A subtotal esophagectomy and a lymph node dissection was performed in which reconstruction was made by using a gastric tube avoiding the gastric cancer lesion. We also reviewed previous reports of 22 cases that had synchronous superficial esophageal and gastric cancer, and discussed the indications and methods of operation.

Prognostic impact of micrometastatic tumor cells in the lymph nodes and bone marrow of patients with completely resected stage I non-small-cell lung cancer.

PURPOSE: This study was designed to substantiate the prognostic impact of occult micrometastatic tumor cells in the lymph nodes (LNs) and bone marrow (BM) in stage I non-small-cell lung cancer (NSCLC) patients using cytokeratin (CK) as a micrometastatic marker and the relationship between the micrometastases in the LNs and BM. PATIENTS AND METHODS: A total of 2,432 hilar and mediastinal LNs were removed during surgery from 115 patients with completely resected stage I NSCLC. The LNs were analyzed for micrometastasis using immunohistochemistry with the biclonal anti-CK antibody AE1/AE3. BM aspirates from 115 patients were immunocytochemically stained with the monoclonal anti-CK antibody CK2. RESULTS: CK-positive (CK+) cells were detected in 42 (1.7%) of 2,432 LNs, in 32 (27.8%) of 115 patients, and in 32 (27.8%) of 115 BM aspirates. There was no relationship between the frequencies of CK+ cells in the LNs and in the BM. The patients with CK+ cells in the LNs had a poor prognosis by both univariate (P =.008) and multivariate analyses (P =.01), whereas the presence of CK+ cells in the BM did not allow prediction of survival (P =.32). The prognostic impact of LNs micrometastasis was independent even after adjusting for the status of BM micrometastasis. CONCLUSION: The detection of lymph nodal micrometastatic tumor cells provides an accurate assessment of tumor staging and has powerful prognostic implications for completely resected stage I NSCLC patients.