An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula.

OBJECTIVES: Some surgical cases of pleural empyema lead to death despite multidisciplinary treatment. The purpose of this study was to identify prognostic factors in cases treated surgically for pneumonia-associated pleural effusions and empyema caused by common bacteria. METHODS: We conducted a retrospective cohort study of 108 surgical patients of empyema who encountered at our hospital between 2011 and 2021. Patients were divided into surviving and non-surviving cases. Factors on admission (age, sex, body mass index, presence of fistula, performance status, pleural fluid culture results, HbA1c, albumin, leukocytes, hemoglobin, body temperature, heart rate, respiratory rate, systolic blood pressure, prognostic nutritional index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and RAPID score) were compared between the two groups. RESULTS: There were 87 cases of pleural empyema caused by pneumonia due to common bacteria. Variables that differed significantly in univariate analysis between the surviving and non-surviving cases in patients' characteristics on admission were fistula (p value < 0.001, odds ratio 20.000, 95% confidence interval 3.478-115.022), positive pleural fluid culture (0.016, 6.591, 1.190-36.502), body mass index < 18.5 (0.001, 16.857, 1.915-148.349), performance status 0-1 (0.007, 11.778, 1.349-102.858), and hemoglobin (0.024, 1.768, 1.077-2.904). Multivariate analysis showed significant differences in the presence of fistula (p = 0.036, CI 1.174-125.825). The odds ratio was 12.154. The mortality rate was 3.8% for non-fistulous empyema and 44.4% for fistulous empyema. In 6 of 9 cases of fistulous empyema, the fistula could be closed. CONCLUSION: Fistula was a significant independent prognostic factor for pneumonia-associated pleural effusions and empyema caused by common bacteria.

[Psoriasis and Psoriatic Arthritis Induced by Nivolumab in a Patient with Advanced Non-Small-Cell Lung Cancer].

BACKGROUND: Immune checkpoint-blocking antibodies may induce specific side effects known as immune-relatedad verse events. CASE PRESENTATION: A 66-year-oldman without any history of autoimmune disease was referredto our hospital for treatment of lung cancer in the right upper lobe. The tumor was diagnosed as Stage III A non-small-cell lung cancer by using bronchoscopic biopsy, computedtomography, andFDG -PET. After a single course of cisplatin andpemetrexed , the tumor size increasedremarkably andthe regimen was changedto nivolumab(3mg/kg every 2 weeks). Psoriasis andpsoriatic arthritis were observed after 4 courses of nivolumab. Nivolumab treatment continued, and the oral administration of predni- solone(20mg/day)couldimprove psoriasis andpsoriatic arthritis. However, the lung cancer showedprogressive disease after the 11th course of nivolumab. CONCLUSION: Psoriasis andpsoriatic arthritis were inducedby nivolumab in the patient without any history of autoimmune disease. It is unclear how prednisolone affected nivolumab for the treatment of lung cancer.

[Complete Remission after Weekly Intravenous Nanoparticle Albumin-Bound Paclitaxel in Elderly Patients with Non-Small-Cell Lung Cancer].

Case 1: An 86-year-old man was diagnosed with large cell or squamous cell lung cancer of clinical Stage II A.He was administered nanoparticle albumin-bound paclitaxel(nab-PTX)as fourth-line chemotherapy after monochemotherapy with docetaxel, vinorelbine, and S-1.The patient continues to show complete remission at the 15 courses of nab-PTX.Case 2: A 79-year-old man underwent partial resection of the right lower lung, and the pathological diagnosis was large cell lung cancer of pStage I A.However, recurrence in the right lung and multiple lymph node metastases were identified 3 years after the surgery.He was administered nab-PTX as second-line chemotherapy after vinorelbine monotherapy, and he has shown complete remission for a year.Weekly intravenous nab-PTX may be useful in elderly patients with non-small-cell lung cancer.

Skin rash by gefitinib is a sign of favorable outcomes for patients of advanced lung adenocarcinoma in Japanese patients.

Skin rash is one of the notorious adverse events of gefitinib as well as other epidermal growth factor receptor tyrosine kinase inhibitors. The differences of response rate and frequency of adverse events between ethnic groups are well known. Some reports demonstrated the correlation between development of rash and efficacy in Caucasian patients treated with erlotinib, gefitinib or cetuximab. We analyzed clinical course of Japanese patients of lung adenocarcinoma in order to assess the relation between adverse events and efficacy of gefitinib. Between January 2008 and June 2012, 24 Japanese patients administered gefitinib 250 mg daily. The adverse events were evaluated in accordance with Common Terminology Criteria For Adverse Events v4.0 (CTCAE). Objective response to gefitinib was evaluated with using computed tomography every 1-2 months. The relationship between each adverse event and objective response was examined by chi-square test. The Log-rank Test was used to assess the relationship between the presence of skin rash and overall survival. Twenty four patients with a median age of 67 years (range 55-89) entered were 16 female and 8 male patients; the pathological diagnosis of all patients was adenocarcinoma. Skin rash in CTCAE occurred in 10. The objective response and overall survival among the patients with skin rash was significantly superior to the patients without skin rash. Skin rash by gefitinib correlates with improved clinical outcomes among advanced lung adenocarcinoma patients.

Gefitinib frequently induces liver damage in patients with lung adenocarcinoma previously treated by chemotherapy.

BACKGROUND: Gefitinib is known as one of the agents for treating patients with both advanced lung cancer and an epidermal growth-factor receptor mutation. In the epidermal growth-factor receptor-mutant advanced non-small-cell lung cancer population, gefitinib therapy has been associated with increased response rate, longer progression-free survival, and better quality of life compared to other anticancer drugs. However, gefitinib has to be discontinued for patients in whom adverse events occur, even if it is still effective. Here, we retrospectively assessed the clinical course of patients receiving gefitinib therapy, with a particular focus on liver damage. PATIENTS AND METHODS: Of 24 Asian patients treated with 250 mg gefitinib daily at Kanagawa National Hospital, Japan, between January 2008 and June 2012, grade 3 liver damage (Common Terminology Criteria for Adverse Events, version 4.0) occurred in nine and were eligible for our assessment. The regimen was subsequently changed to alternate-day administration. The relationships between liver damage and each clinical factor were retrospectively examined using Fisher's exact test. RESULTS: Of the nine patients with liver damage, seven had previous exposure to another anticancer drug. There was a significant relationship between the incidence of liver damage and previous chemotherapy (P = 0.009). The objective response rates of patients treated with daily gefitinib 250 mg and alternate-day gefitinib following liver damage were 66.7% and 46.7%, respectively; these were not significantly different (P = 0.597). CONCLUSION: Gefitinib for advanced adenocarcinoma patients who have previously undergone chemotherapy should be used cautiously and liver function monitored closely, because it frequently induces significant liver damage. The alternate-day administration of gefitinib may be a suitable option for patients in whom daily gefitinib therapy induces liver damage.

A computer-aided diagnosis (CAD) system in lung cancer screening with computed tomography.

We evaluated a computer-aided diagnosis (CAD) system with automatic detection of pulmonary nodules for lung cancer screening with computed tomography (CT). Five hundred and eighteen participants were examined with low-dose helical CT during a lung cancer screening by three respiratory physicians according to the General Rule edited by the Japan Lung Cancer Society. Four cases were detected by CAD and pathologically diagnosed as lung cancer. We compared the detection capability of the physician and CAD in 301 participants. Three physicians determined 75/301 (24.9%) participants as "e" (suspicious of lung cancer) in consensus without CAD, while 3 participants were added to "e" with CAD. Three physicians did not independently judge as "e" in 14 (18.7%), 16 (21.3%) and 16 (21.3%) out of 75 participants. CAD could not identify 17 (22.7%) nodules of 75 participants, and all 17 were less than 6 mm in diameter. The CAD system offers a useful second opinion when physicians examine patients at lung cancer CT screenings.

A case of multidrug-resistant (MDR) tuberculosis with collapse of the left lung after hemoptysis.

An 82-year-old female was admitted to our hospital with multidrug-resistant (MDR) tuberculosis, defined as resistance to both isoniazid and rifampicin. Chest X-ray showed massive infiltrates with a large cavitary lesions in the left lung field. No antituberculous agents were useful in improving her clinical condition and at 6th months after admission, she exhibited sudden onset of massive hemoptysis, which was successfully treated by bronchial artery embolization. After hemoptysis, her chest X-ray showed collapse of the left lung and computed tomography showed a coagula-like shadow in the left main bronchus, and sputum examination revealed no Mycobacterium tuberculosis colonies. The patient was discharged 5 months after the onset of hemoptysis.

A case of pulmonary adenocarcinoma associated with hypertrophic osteoarthropathy due to vascular endothelial growth factor.

A 62-year-old male patient was admitted, because a chest X-ray examination revealed an abnormal shadow (4 cm in diameter) in the left upper lobe. A transbronchial lung biopsy showed the features of adenocarcinoma. Chest and abdominal computed tomography (CT) scan showed the features of lymphangitis carcinomatosa, and bilateral metastatic adrenal tumors. After effective chemotherapy, he complained of arthralgia and a bone scintigram showed abnormal uptakes in his bilateral shoulder, knee and wrist. He was diagnosed with pulmonary hypertrophic osteoarthropathy (PHOA). The serum level of vascular endothelial growth factor (VEGF) was elevated to 424 pg/ml, while serum growth hormone (GH) and GH-releasing hormone were normal. Immunohistochemical analysis showed positive features of VEGF in the pulmonary tumor cells. He died of cachexia on May 2nd, 2001, more than 2 years after the diagnosis of pulmonary adenocarcinoma at stage IV.