Postintubation tracheal stenosis 35 years after neonatal resuscitation.

INTRODUCTION: Postintubation tracheal stenosis involves granulation or cicatrization of the tracheal epithelium. It is progressive and can become life-threatening within a few months after extubation. PRESENTATION OF CASE: We here report a case of tracheal stenosis with a delayed manifestation, presenting 35 years after endotracheal intubation for neonatal resuscitation. A female patient complained of dyspnea during pregnancy. Bronchoscopy revealed 75% constriction of the tracheal lumen by cicatrization, from the 2nd to 4th tracheal rings. After child-birth, the scar tissue was ablated using argon plasma coagulation. DISCUSSION: The patient had no significant medical history, such as severe airway infection or cervical/chest trauma, which might have caused the circumferential cicatricial tracheal stenosis, other than the endotracheal intubation she had undergone for neonatal resuscitation. Therefore, we considered this to reflect postintubation tracheal stenosis with delayed manifestation. CONCLUSION: Delayed postintubation tracheal stenosis should be taken into consideration, when a patient suffers from suffocating tracheal stenosis.

The approach of scratch-imprint cytology: Is it an alternative to frozen section for intraoperative assessment of pulmonary lesions?

To address the diagnostic performance of scratch-imprint cytology (SIC), in this study we compared intraoperative diagnoses of pulmonary lesions between SIC and frozen section histology (FSH) for accuracy with respect to the final pathological diagnosis. We histologically divided 206 pulmonary lesions (resected surgically) into two groups (benign and malignant) and compared each intraoperative diagnosis by SIC and FSH with the final pathological diagnoses. We also examined the radiological existence of pure ground-glass opacity (GGO) nodules in each group. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 91.5%, 100%, 100%, 63.6%, and 92.6%, respectively for SIC, and 98.2%, 100%, 100%, 92.1% and 98.5%, respectively, for FSH. Thus, we concluded that diagnosis by SIC is reliable for malignancy, but not for benign lesions. All pure GGO nodules (19; 9.2%) were noninfectious and malignant with a high accuracy of FSH diagnosis (100%), in comparison with those of low accuracy with a SIC diagnosis (57.9%). SIC can be an appropriate intraoperative diagnostic tool where multiple cytotechnologists observe intraoperative SIC preparations scratched evenly across the whole lesion including the peripheral area of the mass.

A 10-Year History of Anti-Smoking Campaigns and Enlightenment Activities for Chronic Obstructive Pulmonary Disease for Citizens at the Plaza in Ebina City.

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) is 8.6% in Japan and 10% worldwide. Unfortunately, many patients with COPD are not correctly identified and appropriately educated regarding the condition. In this paper, we demonstrate that some citizens of Ebina City with symptoms suspicious for COPD, such as cough, sputum production, and shortness of breath, have undiagnosed COPD. We describe our activities to raise awareness of COPD through a 10-year campaign. METHODS: From 2006 to 2015, we developed activities to raise awareness of COPD, including public lectures, utilization of pulmonary function tests, and questionnaires on subjective symptoms and knowledge of COPD. RESULTS: Among 1,206 participants aged>40 years, COPD was suspected in 5.6%, as indicated by airway obstruction (i.e. forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio (FVC) <0.70). However, most of these participants were not diagnosed with COPD. Furthermore, half of these participants had not consulted a medical institution despite demonstrating symptoms. Results of the COPD awareness questionnaire, which was administered to 1,055 people, indicated that 65% of survey respondents were unaware of COPD. CONCLUSIONS: There are individuals with symptoms suspicious for COPD who are unaware of the disease at the Plaza in Ebina City. Clinicians have a responsibility to raise public awareness of COPD and to reduce the prevalence of COPD and its associated mortality.

Epithelial-mesenchymal Transition (EMT) is Correlated with Patient's Prognosis of Lung Squamous Cell Carcinoma.

Epithelial-mesenchymal transition (EMT) is an important step leading to invasion and migration of various cancer cells, and are characterized by decreased E-cadherin as an epithelial marker, and increased vimentin as a mesenchymal marker. The present study focused on the clinicopathological significance of E-cadherin and vimentin expression in lung squamous cell carcinoma (SqCC). Immunohistochemically, E-cadherin expression patterns were classified into two types: preserved or reduced; and vimentin expression patterns were also divided into two types: positive or negative. The univariate analyses showed six factors associated with increased mortality: tumor size (P = 0.031), lymph node metastasis (P < 0.001), lymphatic invasion (P < 0.001), histological differentiation (P = 0.036), E-cadherin reduced expression (P < 0.001), and vimentin positive expression (P = 0.004). Multivariate analysis demonstrated that E-cadherin reduced expression (P < 0.001), vimentin positive expression (P = 0.028), lymph node metastasis (P < 0.001), and age (P = 0.020) were independent predictors of patient mortality. There may be some correlation between E-cadherin and vimentin expression (P = 0.017), but the correlation coefficient was 0.235. The complete EMT and the incomplete EMT type were associated with a poor prognosis (p < 0.001 and p=0.036, respectively). The overall survival rate after curative resection was significantly lower in patients with the complete EMT type (reduced E-cadherin / positive vimentin). In conclusion, both E-cadherin and vimentin are independent predictors of mortality, and the EMT phenotype is a significant indicator of poor prognosis in lung SqCC.

Use of a titanium alloy (Chest Way) in the surgical stabilization of flail chest.

To avoid the complications of internal pneumatic stabilization for flail chest, we performed stabilization of the chest wall with a metal bar using the Nuss procedure. Here, we used a highly elastic lightweight biocompatible titanium alloy Chest Way (Solve Corporation, Kanagawa, Japan), enabling magnetic resonance imaging. The patient was a 37-year-old man who sustained injuries in a car crash. Gradually increasing subcutaneous emphysema was present. Bilateral pleural drainage and tracheal intubation were conducted on the scene, and a peripheral venous line was established. The patient was then transferred to our hospital by helicopter. A titanium alloy Chest Way was inserted to manage his flail chest accompanied by multiple rib fractures on the left side. Two days later, artificial respiration was no longer required.

Ki-67 labeling index affects tumor infiltration patterns of lung squamous cell carcinoma.

Ki-67 is a nuclear protein that is expressed during the G1, S, G2 and M phases of the mitotic cell cycle. A previous study categorized tumor infiltration patterns (INF), of which INFc indicated cancer nests exhibiting infiltrative growth and an unclear boundary between tumor tissue and surrounding healthy tissue. The present study used the Ki­67 labeling index (Ki­67 LI) as an indicator of cell proliferation, in order to examine the factors affecting INF in lung squamous cell carcinoma (SqCC). SqCC specimens (89) were classified into two groups: High­grade cell proliferation (Ki­67 LI ≥30%) and low­grade cell proliferation (Ki­67 LI <30%). However, a high Ki­67 LI was significantly associated with cases that had an INFc component [INFc(+); P=0.03]. Univariate analyses indicated that INFc(+) was a predictor of venous invasion [P=0.032; odds ratio (OR), 2.615; 95% confidence interval (95% CI), 1.085­6.305], scirrhous stromal type (P<0.001; OR, 6.462; 95% CI, 2.483­16.817) and high Ki­67 LI (P=0.018; OR, 12.543; 95% CI, 1.531­102.777). Multivariate logistic analyses indicated that high Ki­67 LI was the strongest predictor of INFc(+) (P=0.028; OR, 8.027; 95% CI, 1.248­51.624). In conclusion, high­grade cell proliferation activity may contribute to aggressive infiltrative growth of lung SqCC.

Sternal Segment Dislocation in a Child Treated by Conservative Observation.

Sternal segment dislocation is rare in children, with only eight cases appearing in the literature. Four of the six reports recommended surgical treatment such as excision or open reduction and fixation [1-4], while the remaining two reports recommended conservative observation. Therefore, it remains unclear whether surgical treatment is necessary. We report a case of sternal segment dislocation in a child. Although the segment had rotated 90°, it was remodeled. We now believe that surgical treatment is not necessary for this condition.

Congenital pericardial defect: a case of right pericardial partial absence with normal parietal pleura [corrected].

Congenital pericardial defect (CPD) is a rare cardiovascular anomaly. A right-sided CPD is much rarer than left-sided defects. Usually both the pericardium and parietal pleura are absent. We report a rare case of a right partial CPD involving the right atrial appendage, suspected by computed tomography and cine magnetic resonance imaging, and confirmed by thoracoscopy, which also demonstrated a normal parietal pleura.

Successful treatment of penetrating chest injury caused by a crossbow.

A 67-year-old man presented with a crossbow injury sustained in a suicide attempt during which he fixed the crossbow to a table. Although he retired to bed without treatment on the day of the initial injury, his pain increased the following day, and he was admitted to our hospital. On arrival, his vital signs were stable and a 10-mm diameter crossbow arrow that had penetrated the right anterior chest remained in place. Chest computed tomography revealed suspected damage to the right middle lobe, diaphragm, and liver. A right anterior thoracotomy was performed with partial resection of the middle lobe, diaphragm repair, and arrest of hepatic bleeding. There were no complications, and his postoperative course was uneventful. On day 12 after surgery, he was transferred to the psychiatry department of another hospital for treatment of his depression.

[Acute hospital collaboration with the region].

The palliative care team of Tokai University Hospital began its activities in 2004. After several changes in its organization, the activities of the palliative care team have become well known, and this department has become very active. Palliative care at our hospital has now broadened its scope and now includes both inpatients and outpatients. Initially, the patients primarily consisted of terminal-stage cancer patients, but in recent years patients who are being treated for cancer have also been included in the palliative care department. In terms of our collaboration with the region, the health care providers responsible for palliative care are making continued efforts to establish good relationships through regular scheduled palliative care training workshops and study sessions. Regional collaborations with oncologists is the ultimate/primary goal. As an educational institution we conduct clinical practical training and clinical training in core hospitals and private practices with medical students and junior resident physicians. However, few of these training institutions are home-care-supporting clinics or home-care-supporting hospitals. It remains unclear whether medical students and resident physicians are involved in home care. Knowledge of palliative care has gradually increased among the health care providers at our hospital. However, the dissemination of knowledge about home care among medical students, resident physicians, and oncologists is found to be lacking; hence, we have made this our goal. Another goal of ours would be to train existing physicians to equip them with knowledge and experience necessary for dealing with home care.

Laminin-5γ2 chain expression is associated with tumor cell invasiveness and prognosis of lung squamous cell carcinoma.

Our previous study showed that tumor budding is a significant indicator of a poor prognosis in lung squamous cell carcinoma patients. Tumor budding-positive (Bud(+)) cases of lung squamous cell carcinoma (SqCC) showed locally aggressive growth, and the positivity was a useful indicator of the lymph node status and prognosis. The present study focused on the clinicopathologic significance of laminin-5γ2 chain expression for local aggressiveness in lung SqCC. Laminin-5γ2 chain immunohistochemical stains in tissue samples were divided into three distinct types: basement membrane (B type; laminin-5γ2 present in basement membrane), cytoplasmic (C type; laminin- 5γ2 present in intracellular matrix), and invasive front (F type; laminin-5γ2 present in cytoplasm, and strongly in part of peripheral nest). The F type was more common in Bud(+) cases than tumor budding-negative (Bud(-)) cases; B and C types were less common in Bud(+) cases (P 〈 0.001). The F type was more closely associated with decreased overall survival than the B and C types (P 〈 0.001 for both). Univariate analysis showed that the F type could be used to predict tumor size, lymph node metastasis, lymphatic invasion, tumor infiltrative patterns, tumor budding, and laminin-5γ2 chain staining. Multivariate analysis showed that laminin-5γ2 chain staining and tumor budding could be used to predict patient mortality (P 〈 0.001 and P = 0.005, respectively). The overall survival rate after curative resection was lower in patients with the F/Bud(+) type than in those with B+C/Bud(-) and B+C/Bud(+) types (P < 0.001 for both, log-rank test), and also lower with the F/Bud(-) type than the B+C/Bud(-) type. On the other hand, there was no significant difference between the F/Bud(+) and F/Bud(-) types. In conclusion, both laminin- 5γ2 chain staining and tumor budding are associated with tumor cell invasiveness and are independent predictors of mortality in lung SqCC patients.

Tumor budding is a significant indicator of a poor prognosis in lung squamous cell carcinoma patients.

Lung cancer is a leading cause of cancer mortality worldwide and patients occasionally develop local recurrence or distant metastasis soon after curative resection. Reports of new therapeutic strategies for lung squamous cell carcinoma (SqCC) are extremely rare, while selective anticancer therapy has been reported for lung adenocarcinoma. The aim of this study was to identify clinicopathological prognostic factors for SqCC. We analyzed tumor budding and infiltrative patterns (INF) in 103 cases of surgically-resected SqCC. Tumor infiltrative patterns were classified into three groups (INFa, b and c) and INFc was infiltrative growth at the tumor invasive front. The cases with an INFc component [INFc(+)]were significantly associated with venous invasion (P=0.014) and the scirrhous stromal type (P<0.001). The overall survival rate of patients with INFc(+) was significantly lower than that of patients without the INFc component [INFc(-); P=0.003]. Tumor budding was defined as a single cancer cell or a small nest of up to four cancer cells within stromal tissue. The cases with tumor budding [Bud(+)] were significantly associated with lymph node metastasis (P=0.001), lymphatic invasion (P=0.002), INFc(+) (P<0.001) and the scirrhous stromal type (P=0.014). Patients with the Bud(+) type had a lower overall survival rate than patients with the Bud(-) type (P<0.001). Multivariate analysis demonstrated that tumor budding [hazard ratio (HR), 2.766; 95% confidence interval (CI), 1.497-5.109] and lymph node metastasis (HR, 1.937; 95% CI, 1.097-3.419) were independent predictors of mortality. In conclusion, tumor budding is a significant indicator of a high malignant potential and poor prognosis in SqCC of the lung.