Knotless suture and hydrocolloid method improves chest drain wound complication.

OBJECTIVE: Ligation is a widely used wound closure method after chest drain removal in thoracic surgery. Knotless suture, which does not require ligation or suture removal, has been developed and is currently used in our institution. This study compared the efficacy of the drain wound closure method between knotless suture and our previous mattress suture. METHODS: We examined the clinical performance of knotless suture for chest drain wound closure in 117 patients who underwent surgery following this method in our department from October 2020 to April 2021. We compared outcomes with those of mattress suture using 2-0 nylon in 115 patients who underwent thoracic surgery at our institution between October 2018 and April 2019. Hydrocolloid dressing is applied to the drain wound after chest drain removal in a knotless suture. We conducted an analysis of both groups based on the condition of wound closure and drain wound complication. RESULTS: Appropriate wound closure was obtained and no patient required a prolonged hospital stay because of incomplete wound closure in both methods. The rate of chest drain wound infection for knotless suture (0.0%, 0/117 patient) was significantly lower than that of mattress suture (5.2%, 6/115 patients) at the outpatient follow-up (p = 0.01). The rate of delayed drain wound healing was also significantly lower than that of mattress suture (0.9% vs. 7.0%; p = 0.02). CONCLUSIONS: The results of knotless closure were better than those of conventional mattress suture regarding wound complications. Moreover, knotless suturing requires no suture removal, indicating its usefulness.

[Experience with Secondary Pulmonary Lymphoma Diagnosed by Surgical Biopsy].

Pulmonary malignant lymphoma presents diverse imaging findings, thus making an imaging-based diagnosis difficult. Furthermore, because of the low histological diagnostic rate of approximately 30% based on transbronchial lung biopsy, there are difficulties in the early diagnosis of pulmonary malignant lymphoma. We report a case of pulmonary malignant lymphoma that was difficult to diagnose until a surgical biopsy was performed. A 72-year-old female was referred to our hospital with an abnormal chest shadow on a medical examination. Chest computed tomography(CT) scan demonstrated groundglass opacity and consolidation in both lung fields. Bronchoscopy was performed but a histological definitive diagnosis could not be obtained. We suspected organized pneumonia and initiated steroid therapy that resulted in improvement in the chest shadow. However, new multiple lung nodules and mediastinal lymphadenopathy were noticed on CT scan performed 9 months after the initiation of steroid therapy, and a lung biopsy and mediastinal lymph node biopsy were performed. Finally, the diagnosis was malignant lymphoma with pulmonary infiltrates.

A prospective, multi-institutional phase II study of induction chemoradiotherapy followed by surgery in patients with non-small cell lung cancer involving the chest wall (CJLSG0801).

OBJECTIVES: The standard therapy for patients with T3N0-1M0 non-small cell lung cancer (NSCLC) involving the chest wall is considered surgical resection and adjuvant therapy. However, the compliance of adjuvant therapy is relatively low, and the prognosis for those patients has been unsatisfactory. Therefore, we conducted a phase II study of induction chemoradiotherapy followed by surgery with the aim of improving the survival. PATIENTS AND METHODS: This treatment strategy consisted of induction chemotherapy (two cycles of cisplatin at 80mg/m2 on Day 1 and vinorelbine at 20mg/m2 on Days 1 and 8) concurrent with radiotherapy (40Gy in 20 fractions) followed by surgery. The inclusion criteria were patients with resectable T3N0-1M0 NSCLC involving the chest wall who were 20-70 years of age. The primary end point was the 3-year survival, assuming an expected rate of 67%. RESULTS: From January 2009 to November 2012, 51 eligible patients were enrolled. Induction therapy was completed as planned in 49 (96%) patients without treatment-related death, and 25 (51%) had a partial response. Complete resection combined with the involved chest wall was achieved in 46 (92%) patients, and a pathologic complete response was seen in 13 (26%) patients. Five patients experienced major postoperative complications, and 1 patient died of acute exacerbation of interstitial pneumonia. With a median follow-up period of 42 months, the 3- and 5-year overall survivals of all registered patients were 77% and 63%, respectively. There was a significant difference in the survival rate between patients with a pathologic complete response and those with a residual tumor (p=0.039). CONCLUSION: The mature results of this study in a multi-institutional setting showed the treatment strategy to be safe and effective with a high rate of pathologic response for patients with NSCLC involving the chest wall.

[Parathyroid Hormone-related Peptide (PTHrP) Producing Lung Cancer Presenting Hypercalcemia; Report of a Case].

An 82-year-old man was admitted to our hospital with hemoptysis and weight loss. Chest computed tomography(CT) showed a 90 mm mass with cavity formation in the right lower lobe adjacent to chest wall. Laboratory data revealed hypercalcemia and elevation of parathyroid hormone-related protein C (PTHrP). He was diagnosed as squamous cell carcinoma of lung by transbronchial lung biopsy (TBLB) [cT3aN1M0]. Nausea and anorexia due to hypercalcemia became worse and a right middle and lower lobectomy was performed because of difficult control of symptoms by medicine and worsening of his general condition. His symptoms were improved immediately after surgery.

[Pulmonary lymphoepithelioma-like carcinoma; report of a case].

A 66-year-old male was referred to our hospital due to an abnormal chest shadow in the left lung detected on a medical examination. Chest computed tomography(CT) revealed a round mass of 40 mm in diameter in the left S10. Positron emission tomography (PET) scan showed fluorodeoxy glucose (FDG) accumulation and surgical biopsy was done. The intraoperative frozen histopathological diagnosis was mucosal associated lymphoid tissue( MALT) lymphoma or pseudoinflammatory tumor. By postoperative pathology, the mass was finally diagnosis as lymphoepithelioma-like carcinoma (LELC) of the lung, pT2aN0M0 stage I B.After a month, left lower lobectomy with mediastinal lymph node dissection was performed. The association with Epstein-Barr virus was not demonstrated by EBER in situ hybridization. The patient was well without relapse at 24 months after surgery.

Trimodality therapy for lung cancer with chest wall invasion: initial results of a phase II study.

BACKGROUND: The chest wall is the most common neighboring structure involved by locally advanced lung cancers. However, the optimal treatment strategy for such tumors has not been established. This phase II trial was therefore conducted with the aim of evaluating whether induction chemoradiotherapy followed by surgery improves the survival of patients with T3N0 or T3N1 lung cancer involving the chest wall. METHODS: Patients with resectable T3N0 or T3N1 non-small cell lung cancer involving the chest wall were candidates for this study. Induction therapy consisted of two cycles of cisplatin and vinorelbine chemotherapy concurrent with 40 Gy of radiation. Surgical resection was performed 3 to 6 weeks after the last day of chemotherapy. RESULTS: From January 2009 to November 2012, 51 eligible patients (40 stage IIB and 11 stage IIIA tumors) were entered in this study. Induction therapy was completed as planned in 49 (96%) patients, and 25 (51%) had a partial response revealed on computed tomography. Forty-eight patients underwent pulmonary resection combined with chest wall resection, and 44 (92%) underwent a complete resection. Pathologic examinations of the resected specimens revealed no viable tumor cells in 12 (25%) cases and minimal residual disease in 31 (65%) cases. Five patients experienced major postoperative complications, and 1 patient died of postoperative exacerbation of interstitial pneumonia. CONCLUSIONS: The initial results of this study showed the treatment regimen to be safe and feasible with a high rate of a pathologic response for patients with lung cancer involving the chest wall in a multiinstitutional setting.

[Ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion; report of a case].

We report a surgical case of ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion. It is often difficult to detect ectopic mediastinal parathyroid tumor during the operation because the tumor is soft, small and buried under mediastinal tissue. After methylene blue 4 mg/kg intravenously administration, the tumor was gradually dyed blue and easily detected and resected by video-assisted thoracic surgery. It is useful of methylene blue for detection of ectopic mediastinal parathyroid tumor.

[Recurrence of inflammatory myofibroblastic tumor of chest wall after radical resection;report of a case].

A 61-year-old male presented with an asymptomatic left chest wall (the 7th rib) tumor detected by positron emission tomography(PET). The increase of tumor size was indicated by computed tomography(CT) scan and complete resection including the 6th to 8th rib was performed due to intraoperative rapid diagnosis as sarcoma. The diagnosis of inflammatory myofibroblastic tumor (IMT) was established by final pathological diagnosis. Three years later, he had a relapse of 2 tumors in left chest wall (the 9th, 10th rib), and surgical resection was performed without chest wall resection. Histological findings of a relapse tumor showed a large size tumor cell and a decrease in the number of plasma cell compared to the 1st tumor. These changes may be related to a clinical aggressive behavior.

[Acute pain at tumor recurrence site induced by vinorelbine infusion].

We present a case of vinorelbine (VNR)-induced acute tumor pain. Oral control-release oxycodone was administered for cancer pain by iliac bone metastasis. In chemotherapy by combined use of VNR and gemcitabine, severe pain in groin, thigh and hip occurred immediately after infusion of VNR. Oral rapid-release oxycodone was administered but the pain lasted half an hour and then resolved spontaneously. In the following course of chemotherapy by same regimen, pre-medication of rapid-release oxycodone did not prevent the pain.

[Mediastinal involvement of thyroid cancer with mediastinal lymph node metastasis; report of a case].

We report a surgical case of mediastinal involvement of papillary adenocacinoma of thyroid with mediastinal lymph node metastasis. A 58-year-old male was admitted to our hospital with laryngeal discomfort. The laryngeal fiber scopy showed left recurrent nerve palsy, although he hadn't noticed hoarseness before admission. An enhanced computed tomography(CT)scan revealed a heterogeneous 3×3 cm mass in the upper mediastinum. The 18F-fluorodeoxyglucose-positron emission tomography( FDG-PET)showed an accumulation of FDG in the mass and also in a mediastinal lymph node. The incisional biopsy on mediastinoscopy revealed a papillary adenocarcinoma of thyroid and a total thyroidectomy with resection of mediastinal lymph node through cervical and reverse-T upper mini-sternotomy approach was performed.

Thermo-sensitive response based on the membrane fluidity adaptation in Paramecium multimicronucleatum.

Relationships between the thermo-sensitive response and membrane lipid fluidity were studied using a ciliated protozoan, Paramecium multimicronucleatum. Paramecium elicits a transient membrane depolarization in response to a cooling stimulus (temperature drop). The depolarization amplitude was largest when the cooling stimulus was started from the culture temperature, whilst when cooling started at a temperature more than 5 degrees C higher or lower than the culture temperature, only a small depolarization was induced. Therefore, the cooling-induced response was dependent on the culture temperature and its sensitivity to the cooling stimulus was highest at the culture temperature. Membrane fluidity measurements of living cells using the fluorescent dye 6-lauroyl-2-dimethylaminonaphthalene (laurdan) showed that the fluidity measured at the culture temperature was almost constant irrespective of the temperature at which the cells had been cultured and adapted, which is consistent with homeoviscous adaptation. The constant fluidity at the culture temperature quickly decreased within a few seconds of application of the cooling stimulus, and the decreased fluidity gradually readapted to a constant level at the decreased temperature within 1 h. When the constant fluidity at culture temperature was modified by the addition of procaine or benzyl alcohol, the cooling-induced depolarization was completely abolished. These results suggest the possibility that the adaptation of fluidity to a constant level and its quick decrease below the constant level activate cooling-sensitive channels to elicit the transient depolarization.

18F-FDG uptake by primary tumor as a predictor of intratumoral lymphatic vessel invasion and lymph node involvement in non-small cell lung cancer: analysis of a multicenter study.

UNLABELLED: Intratumoral lymphatic vessel invasion and lymph node involvement are important factors in the planning of therapeutic strategies, particularly limited surgical resection in patients with non-small cell lung cancer. (18)F-FDG uptake within the primary lesion correlates with aggressiveness on PET studies. The more metabolically active the tumor, the more aggressive are the findings. The aim of this multicenter study was to determine whether (18)F-FDG uptake of the primary tumor is a predictor of intratumoral lymphatic vessel invasion and lymph node metastasis in patients with non-small cell lung cancer. METHODS: One hundred thirty-two patients with lung cancer were studied. All patients underwent a thoracotomy within 4 wk of the (18)F-FDG PET study. A 3-point visual scoring system (low, moderate, or high grade in comparison with mediastinal activity) was used to interpret (18)F-FDG uptake within the primary lesions. The degree of (18)F-FDG uptake in the primary tumor was correlated with the incidence of intratumoral lymphatic vessel invasion and lymph node involvement. Multivariate analysis was performed with logistic multivariate analysis to assess the joint effects and interactions of the variables (age, sex, tumor size, histology, and (18)F-FDG uptake) on intratumoral lymphatic vessel invasion and lymph node involvement. RESULTS: Intratumoral lymphatic vessel invasion and lymph node involvement were found in 7.1% and 5.9%, respectively, of the patients classified in the low-grade group, and in 14.3% and 10.0%, respectively, of the patients classified in the moderate-grade group. In contrast, of the patients classified in the group with high (18)F-FDG uptake, intratumoral lymphatic vessel invasion and lymph node involvement were found in 39.7% and 38.9%, respectively. Multivariate analysis showed that only (18)F-FDG uptake was a significant factor for intratumoral lymphatic vessel invasion and that tumor size and (18)F-FDG uptake were significant factors for lymph node involvement. Of the patients in the high-grade group whose tumors were classified as > or =3 cm in size, lymph node involvement was found in 51.5%. In contrast, of the patients in the low- to moderate-grade group whose tumors were classified as <3 cm in size, lymph node involvement was found in only 9.1% (P < 0.0001). CONCLUSION: Patients with a low to moderate (18)F-FDG uptake in the primary lesion had a significantly lower risk of concurrent intratumoral lymphatic vessel invasion and nodal involvement than did patients with a high (18)F-FDG uptake. In patients with non-small cell lung cancer, (18)F-FDG uptake by the primary tumor is a strong predictor of intratumoral lymphatic vessel invasion and lymph node metastasis.

[Clinical usefulness of reservoir system with a coaxial catheter].

We have developed a new implantable catheter and port system (reservoir) with a 2.9 Fr coaxial catheter. This study was undertaken to evaluate the initial results of the new reservoir system. Fifty-three patients with liver neoplasms underwent implantation of this reservoir owing to tortuousity, angulation, and stenosis of the hepatic arteries, and received repeated arterial infusion chemotherapy. Implantation was technically successful in all patients. Hepatic arterial occlusion occurred at rates of 13.7% at six months and 35.3% at one year. There were no major complications apart from port infection in two patients. This reservoir with a 2.9 Fr catheter expands the indications of hepatic arterial infusion chemotherapy.