Successful treatment of catamenial hemoptysis by single-incision thoracoscopic left S9 + 10 segmentectomy using indocyanine green injection-assisted targeting.

Catamenial hemoptysis is a rare condition. A 28-year-old woman presented with a 1-year history of repetitive hemoptysis occurring on the first day of her menstrual period. Chest computed tomography revealed catamenial hemoptysis during her menstrual period. The patient underwent single-incision thoracoscopic left S9 + 10 segmentectomy using indocyanine green injection-assisted targeting. The endometriosis lesions would not be enhanced by perfusion defects during ICG injection due to the lung contusion. Surgical resection with accurate localization of catamenial hemoptysis was a fundamental treatment method. The localization of lesions using indocyanine green effectively enabled a minimally invasive surgery.

PAK1 as a Potential Therapeutic Target in Male Smokers with EGFR-Mutant Non-Small Cell Lung Cancer.

P21-activated kinases (PAKs) are serine/threonine protein kinases that contribute to several cellular processes. Here, we aimed to determine the prognostic value of PAK1 and its correlation with the clinicopathological characteristics and five-year survival rates in patients with non-small cell lung cancer (NSCLC). We evaluated PAK1 mRNA and protein expression in NSCLC cells and resected tumor specimens, as well as in healthy human bronchial epithelial cells and adjacent healthy lung tissues, respectively, for effective comparison. Immunohistochemical tissue microarray analysis of 201 NSCLC specimens showed the correlation of PAK1 expression with clinicopathological characteristics. The mRNA and protein expression of PAK1 were 2.9- and 4.3-fold higher in six of seven NSCLC cell types and human tumors (both, p < 0.001) than in healthy human bronchial epithelial BEAS-2B cells and adjacent healthy lung tissues, respectively. Decreased survival was significantly associated with PAK1 overexpression in the entire cohort (χ2 = 8.48, p = 0.0036), men (χ2 = 17.1, p < 0.0001), and current and former smokers (χ2 = 19.2, p < 0.0001). Notably, epidermal growth factor receptor (EGFR) mutation-positive lung cancer patients with high PAK1 expression showed higher mortality rates than those with low PAK1 expression (91.3% vs. 62.5%, p = 0.02). Therefore, PAK1 overexpression could serve as a molecular target for the treatment of EGFR mutation-positive lung cancer, especially among male patients and current/former smokers.

Hybrid surgical resection of a tumor invading the superior vena cava.

Recently, hybrid operations featuring vascular interventions have become more common, but applications in the thoracic surgery are few. Superior vena cava (SVC) resection and reconstruction is a typical complex thoracic surgery. Traditional SVC resection/reconstruction requires advanced vascular surgical skills. We developed a simple and safe procedure; we insert a stent during malignant tumor surgery involving the SVC. This approach renders such surgery easier, increasing the probability of success.

Bronchoesophageal fistula secondary to postpneumonectomy like syndrome caused by bilobectomy and postoperative radiation therapy for lung cancer.

Postpneumonectomy like syndrome is a very rare condition and benign bronchoesophageal fistula (BEF) is also uncommon in the adult. Therefore, the probability of occurrence of BEF secondary to postpneumonectomy like syndrome will be extremely rare, and has not been reported yet in the literature. This is the first case report of postpneumonectomy like syndrome combined BEF after bilobectomy and postoperative radiation therapy for lung cancer.

Is severe re-expansion pulmonary edema still a lethal complication of closed thoracostomy or thoracic surgery?

BACKGROUND: Re-expansion pulmonary edema (REPE) is a lethal complication that can occur after inserting a chest tube. However, no clinical research reports have analyzed the progress and treatment of REPE, except for a single case report review. We retrospectively analyzed the common clinical characteristics, clinical progress, and treatment outcome of REPE with respiratory failure. METHODS: We retrospectively reviewed the clinical features, treatment, and outcomes of eight patients with REPE who required ventilator care from March 2004 to March 2018. RESULTS: The mean PaO2/FiO2 ratio of the patients immediately after intubation was 106.5±20.2 (range, 75-128), which indicated severe hypoxia in all cases. On the first day of treatment, most of the patients showed improvement in hypoxia symptoms, and most improved to the extubation level on day 3. The mean duration of ventilator use was 2.5±0.8 days (range, 1-4 days), and the mean duration of inotropic drug use was 1.1±0.7 days (range, 0-2 days). The mean intensive care unit (ICU) stay was 4.4±1.5 days (range, 3-8 days). No deaths were recorded during the study period, and no cases of permanent complications due to REPE were observed. CONCLUSIONS: REPE requiring ventilator care is a lethal disease. However, continued development of ICU care has dramatically decreased mortality. Low positive end-expiratory pressure (PEEP), low tidal and high O2 ventilator care represents the most appropriate treatment for REPE.

Successful use of an EZ-blocker for lung isolation and management in a hemoptysis patient.

When massive hemoptysis develops suddenly, patients typically die due to hypovolemia or airway obstruction. Intubation, endobronchial blocking, and elimination of blood clots are urgently required. However, existing double-lumen tubes and single endobronchial balloon systems are inadequate. We herein report successful EZ-blocker-mediated one-lung ventilation of a patient with a massive hemoptysis who required emergency life-saving surgery.

Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period.

BACKGROUND: Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. METHODS: Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study. Twenty-one patients were under sedation anesthesia (SA group) and 20 patients were under general anesthesia (GA group). In SA group, sedation was done with dexmedetomidine (a loading dose of 1 µg/kg for 10 min and then maintained in dosages of 0.3-1 µg/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in GA group, induction with propofol and rocuronium, intubation with double lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was done. In both groups, thoracoscopic bullectomy was performed in the same manner and all operations were conducted by single surgeon. Time for anesthesia [including emergence time and post-anesthesia care unit (PACU) recovery time] and operation, postoperative pain, sore throat, hoarseness, adverse events (nausea, vomiting, hypotension and bradycardia), dose of rescue analgesic drug used for 24 hours post-operatively and perioperative arterial blood gas analysis were recorded. RESULTS: The times for anesthesia, operation and emergence were significantly shorter in SA than GA. Incidence of sore throat were significantly lower in SA. The difference of other adverse events in the two groups was not significant. CONCLUSIONS: Our study demonstrated that compared to double-lumen intubation with general anesthesia, non-intubation with sedation for bullectomy for primary spontaneous pneumothorax was safe and efficient to reduce perioperative time.

The effect of ketamine on the incidence of emergence agitation in children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia.

BACKGROUND: The rapid emergence and recovery from general anesthesia afforded by sevoflurane is associated with a high incidence of emergence agitation in children. Small doses of ketamine reduce the incidence of emergence agitation. This study compared the effects of ketamine 0.25 mg/kg and 0.5 mg/kg on emergence agitation and postoperative pain. METHODS: The effects of added intravenous ketamine were evaluated in 93 children, ASA I-II, 2-14 years old, undergoing an adenotonsillectomy. The patients were allocated randomly to one of three groups receiving saline (group C), ketamine 0.25 mg/kg (group K0.25) or ketamine 0.5 mg/kg (group K0.5). The children in each group were administered the study drugs 10 minutes before the end of surgery. The recovery characteristics, including the time to extubation, delivery time from the PACU, postoperative nausea and vomiting, agitation and pain were assessed. RESULTS: There were no significant differences in the extubation time, delivery time and postoperative nausea and vomiting between the three groups. There were significant differences in modified CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) between the three groups. The incidence of emergence agitation was low in the K0.25 and K0.5 groups compared to the control group. However, there was no significant difference between the K0.25 and K0.5 groups. CONCLUSIONS: There was no significant difference in the incidence of emergence agitation between K0.25 and K0.5 groups. However, K0.5 group showed a lower pain score than K0.25 group.

Anaphylaxis with angioedema by rocuronium during induction of general anesthesia -A case report-.

Perioperative anaphylaxis is characterized by severe respiratory and cardiovascular manifestations. Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anesthesiologist. A 34-year-old woman was scheduled to undergo endo venous laser therapy of varicose veins. She had no history of allergies and had never undergone general anesthesia. General anesthesia was induced with propofol and rocuronium bromide. Approximately three minutes after rocuronium administration, hypotension and tachycardia developed and angioedema around the eyelids and skin rashes and urticaria appeared. The patient received ephedrine and hydrocortisone with hydration. After achieving stable vital signs and symptom relief, surgery was performed without complications. A postoperative skin dermal test performed to identify the agent responsible revealed a positive skin test for rocuronium.

Anesthetic management in pediatric patient with Angelman syndrome: A case report.

The Angelman syndrome is characterized by an abnormality of chromosome 15, where a subunit of the gamma amino-butyric acid receptor is coded. The clinical features are developmental delay, microcephaly, wide mouth, prognathia which usually do not have problem with intubation. But, muscular atrophy may induce delayed recovery from neuromuscular blockade. Moreover, there are case reports that vagal hypertonia such as severe bardycardia or asystole occurred during anesthesia. We present a 5-year-9-month-old male Angelman syndrome patient who underwent a left and right rectus ophthalmicus muscle recession. We gave him prophylactic glycopyrrolate before anesthetic induction and induced and maintained anesthesia with sevoflurane and oxygen. After that we monitored train-of-four ratio for evaluation of neuromuscular blockade. There is no complication during operation and recovery from anesthesia.