Significance of histologic subtype size as a prognostic indicator in stage IA lung adenocarcinoma.

Background: Predicting prognosis is complex due to a unique characteristic in stage IA lung adenocarcinoma. The feature indicated heterogeneous histologic subtype and ground glass opacity (GGO). Many studies demonstrated different prognoses according to histologic subtype or non-GGO lesion. This study aimed to evaluate the clinical outcomes following each histologic subtype size in stage IA lung adenocarcinoma and identify the prognostic impact of each histologic subtype size. Methods: The medical records of 550 patients with pathological stage IA lung adenocarcinoma were reviewed. Histologic subtype size was estimated by multiplying the tumor's maximum diameter by the proportion of each histologic subtype. Univariate and multivariate analyses were conducted to identify the prognostic role of each histologic subtype size in stage IA lung adenocarcinoma. Results: The median age and tumor size were 63 [25-82] years and 1.8 [0.3-3] cm, respectively. Acinar (42.0%) and lepidic (44.4%) were the most common among the predominant subtype. Each subtype size was estimated and re-categorized following the current staging system. The disease-free interval (DFI) was significantly different following each histologic subtype size. Multivariate analysis for DFI revealed more acinar, micropapillary, and solid subtypes and fewer lepidic subtypes with worse prognoses. Conclusions: The prognosis for DFI is determined through a complex process by various variables in stage IA lung adenocarcinoma. Each subtype size has a more prognostic impact than the predominant subtype.

Comparison of clinical results between high grade patterns in stage I lung adenocarcinoma.

BACKGROUND: The histological subtype has been introduced in invasive lung adenocarcinoma. The predominant micropapillary and solid subtypes are categorized as high-grade patterns and provide a worse prognosis. However, the prognostic analysis of high-grade patterns has not previously been fully investigated. Thus, this study aimed to investigate the prognostic role of high-grade patterns in pathological stage I lung adenocarcinoma. METHODS: Patients with stage I lung adenocarcinoma and micropapillary or solid components were reviewed. Clinicopathological features and clinical course were compared in these subtypes, and prognostic factors were analyzed in high-grade patterns. RESULTS: The patients were classified into five groups based on the presence of micropapillary or solid subtypes, namely, micropapillary predominant, solid predominant, both nonpredominant subtypes, only minor micropapillary subtype, and only minor solid subtype present. Disease-free interval was significantly different, and the micropapillary predominant group showed worse disease-free interval (p = 0.001). Contrastingly, the solid predominant group showed significantly worse overall survival among high-grade patterns (p = 0.035). The multivariate analysis revealed an association between smoking, micropapillary predominant, blood vessel invasion, and visceral pleural invasion with recurrence and more association between solid predominant and visceral pleural invasion with overall survival. CONCLUSIONS: Clinical results were different in stage I high-grade adenocarcinoma. The predominant micropapillary subtype is the independent prognostic factor for recurrence. However, the solid subtype is the significant factor for overall survival. Furthermore, the predominant subtype is the most valuable and independent prognostic factor for predicting recurrence or survival.

Predicting prognosis using a pathological tumor cell proportion in stage I lung adenocarcinoma.

BACKGROUND: Tumor size is a valuable prognostic factor because it is considered a measure of tumor burden. However, it is not always correlated with the tumor burden. This study aimed to identify the prognostic role of pathological tumor proportional size using the proportion of tumor cells on the pathologic report after curative resection in pathologic stage I lung adenocarcinoma. METHODS: We retrospectively reviewed the medical records of 630 patients with pathologic stage I lung adenocarcinoma after lung resection for curative aims. According to the pathologic data, the proportion of tumor cells was reviewed and pathological tumor proportional size was estimated by multiplying the maximal diameter of the tumor by the proportion of tumor cells. We investigated the prognostic role of pathological tumor proportional size. RESULTS: The median tumor size was 2 cm (range: 0.3-4), and the median pathological tumor proportional size was 1.5 (range: 0.12-3.8). This value was recategorized according to the current tumor-node-metastasis (TNM) classification, and 184 patients showed down staging compared with the current stage. The survival curve for disease-free survival using pathological tumor proportional size showed more distinction than the current stage classification. Multivariate analysis revealed that a down stage indicated a favorable prognostic factor. CONCLUSION: Pathological tumor cell proportional size may be associated with prognosis in stage I lung adenocarcinoma. If the pathological tumor proportional size shows a downward stage, it may indicate a smaller tumor burden and better prognosis.

Prognostic impact according to the proportion of the lepidic subtype in stage IA acinar-predominant lung adenocarcinoma.

BACKGROUND: Adenocarcinoma is the most common type of lung cancer and most adenocarcinomas have heterogeneous subtypes. Acinar-predominant adenocarcinoma is the most common. This study aimed to identify the prognostic impact of other mixed histological subtypes in acinar-predominant lung adenocarcinoma. METHODS: The medical records of patients with pathological stage IA acinar-predominant lung adenocarcinoma between January 2010 and April 2016 were reviewed. The patients were divided into two groups according to the proportion of the lepidic subtype, with a cutoff value of 20%, and prognostic factors were analyzed. RESULTS: A total of 215 patients with stage IA acinar-predominant adenocarcinoma were reviewed. The 20% or more lepidic subtype group had a low value of SUVmax (p = 0.001), good differentiation (p < 0.001) and a low incidence of the solid histological subtype (p = 0.016). Recurrence was significantly lower in the 20% or more lepidic subtype group (p = 0.008). The disease-free survival (p = 0.007) and overall survival (p = 0.046) were significantly different between the two groups. Multivariate analysis showed that lymphovascular invasion (p = 0.006) and no or less than 20% lepidic subtype (p = 0.036) were significant prognostic factors for disease-free survival. CONCLUSIONS: The lepidic proportion may be useful to predict recurrence in acinar-predominant stage IA lung adenocarcinoma.

Significant difference in recurrence according to the proportion of high grade patterns in stage IA lung adenocarcinoma.

BACKGROUND: Patients with early lung cancer are the best candidates for surgical resection. However, those patients with high grade patterns (micropapillary or solid) do not have a good prognosis, even if they have been diagnosed with stage I lung adenocarcinoma. A new modified grading system has been introduced and this study aimed to identify the prognostic role of the new grading system in patients with stage IA lung adenocarcinoma. METHODS: Patients with pathological stage IA lung adenocarcinoma, according to the eighth TNM classification who underwent curative resection, were reviewed. The pathological data of stage IA adenocarcinoma was reviewed 1 (grade 1: lepidic predominant with no or less than 20% of high grade patterns, grade 2: acinar or papillary predominant with no or less than 20% of high grade patterns, grade 3: any tumor with 20% or more of high grade patterns). Prognostic factors were analyzed for disease-free interval (DFI) and overall survival (OS) using Cox proportional models. RESULTS: The medical records of 429 patients with stage IA lung adenocarcinoma were reviewed. DFI (p < 0.001) and OS (p < 0.001) were significantly lower in patients diagnosed with grade 3 compared with grade 1 and grade 2. Multivariate analysis showed that smoking (p = 0.013), value of SUVmax (p = 0.005), lymphovascular invasion (p = 0.004) and grade 3 (p = 0.008) were significant prognostic factors for DFI. CONCLUSIONS: The proportion of high grade patterns showed a different prognosis, even if curative resection had been performed for stage IA adenocarcinoma. This new grading system is more simple and useful in the prediction of a prognosis in patients with stage IA lung adenocarcinoma.

Use of imaging studies to predict postoperative recurrences of primary spontaneous pneumothorax.

BACKGROUND: Bullectomy with pleural procedure is the most effective means of treating primary spontaneous pneumothorax (PSP). However, recurrences after thoracoscopic bullectomy are unexpectedly frequent. Our aim was to identify the premonitory imaging features after thoracoscopic bullectomy that may associate with recurrences in PSP. METHODS: The medical records of all patients undergoing thoracoscopic bullectomy for PSP between January 2013 and September 2016 were subject to review. A total of 154 procedures performed on 147 patients qualified for study. Clinical outcomes and characteristics of patients were reviewed and serial chest radiographies were assessed, analyzing risk factors for postoperative recurrences. RESULTS: Median age of the male-predominant cohort (93.5%) was 19 (range, 15-39) years. Median operative time was 35 min, none reflecting complications. Postoperatively, diaphragmatic tenting was identified in 78 patients (50.6%), and pleural residual cavity was identified by chest radiography in 102 (66.2%). After discharge, remained diaphragmatic tenting (38/154, 24.7%) and pleural residual cavity (52/154, 33.8%) were identified by chest radiography. In univariate analysis, remained diaphragmatic tenting (P=0.026) and length of pleural residual cavity (P=0.024) emerged as risk factors for recurrence; and both reached significance in multivariate analysis (P=0.020 and P=0.018, respectively). CONCLUSIONS: Remained diaphragmatic tenting after thoracoscopic surgery for PSP may be associated with the risk of postoperative recurrence.

Hypertension is associated with oral, laryngeal, and esophageal cancer: a nationwide population-based study.

Several studies have reported an association between hypertension and upper aerodigestive tract cancer, but no large-scale, population-based studies have been conducted to confirm this.The aim of this study was to explore the association between hypertension and risk of upper aerodigestive tract cancer in Koreans. Participants who underwent a national health screening examination from January 1 to December 31, 2009 (n = 9,746,606) were enrolled. We assessed the development of oral, laryngeal, or esophageal cancer until 2016 using records from the Korean Health Insurance claims database during the study period. During the seven-year follow-up period, 6,062, 2,658, and 4,752 subjects were newly diagnosed with oral, laryngeal, and esophageal cancer, respectively. Participants with metabolic syndrome had the highest risk of developing oral cancer (hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.03-1.16), laryngeal cancer (HR 1.27, 95% CI 1.17-1.38), and esophageal cancer (HR 1.11, 95% CI 1.04-1.19). Hypertension was a remarkable risk factor for each cancer (HR 1.11, 95% CI 1.04-1.17 for oral cancer; HR 1.23, 95% CI 1.13-1.33 for laryngeal cancer; HR 1.25, 95% CI 1.18-1.33 for esophageal cancer) after adjusting for age and other variables including gender, smoking status, alcohol intake, exercise, body mass index, and diabetes. Patients with untreated hypertension were at highest risk of developing oral cancer (HR 1.15; 95% CI 1.05-1.26), laryngeal cancer (HR 1.25; 95% CI 1.09-1.44), and esophageal cancer (HR 1.47; 95% CI 1.33-1.63) after adjusting for confounders. Hypertension was associated with the risk of oral, laryngeal, and esophageal cancer, despite of the lack of detailed biochemical information including the cancer cell types (squamous cell carcinoma or adenocarcinoma), cancer stage, physical findings and other medical history. Further studies are warranted to determine the reasons for this association and to establish effective interventions in this vulnerable population.

Should We Consider the Resected Lung Volume in Primary Spontaneous Pneumothorax?

BACKGROUND: Although bullectomy is the most curative treatment in primary spontaneous pneumothorax (PSP), postoperative recurrence is not uncommon. New bulla formation at the staple line is the most common cause of recurrence. However, the mechanism is not known. We believe that the pressure gradient plays the main role in new bulla formation. A large resection amount induces a prolonged pressure gradient for obliteration of the residual space. This study aimed to identify the association between resected lung volume and recurrence. METHODS: The medical records of patients who underwent video-assisted thoracoscopic surgery (VATS) bullectomy were reviewed between October 2010 and December 2017. A total of 396 patients underwent surgery for spontaneous pneumothorax. The electronic medical records (EMRs) of the patients were reviewed. Patients with secondary spontaneous pneumothorax were excluded. Patients who were diagnosed with emphysema on CT were excluded. Patients with PSP were excluded from the study if the bulla was not located in the apex or if there was no ruptured bulla at the time of the operation. Patients who lacked EMRs were also excluded. We reviewed the medical records of 276 patients. The apical resected lung volume was estimated using a conical volumetric formula with the use of the specimen size. The risk factors for postoperative recurrence were analyzed. RESULTS: The median age was 19 years old (range 13-36). A total of 261 patients were male (94.6%). The median body weight and body mass index (BMI) were 58 kg (range 40-82) and 18.92 (range 15.21-26.47), respectively. In 24 patients, both sides were operated on simultaneously. The resected lung volume was obtained by using a conical volumetric formula, and the value was divided by the BMI value. The median value was 1.43 (0.03-5.67). The median operative time was 35 min (range 15-120). The median postoperative day was 4 (range 2-12). Age (p = 0.006), the value of the resected lung volume divided by BMI (p = 0.003), bilateral bullectomy (p = 0.013) and transverse diameter (p = 0.034) were associated with postoperative recurrence according to the univariate analysis. According to the multivariate analysis, age and the value of the lung volume divided by BMI were significant risk factors for postoperative recurrence. CONCLUSIONS: Younger age and a large resected lung volume and a low BMI are associated with postoperative recurrence after VATS bullectomy for PSP.

Aggressive mycobacterium abscessus on repeated exogenous lipoid pneumonia in the right middle lobe.

A 65-year-old woman with no underlying disease had been repeated the development and improvement of lipoid pneumonia in the Rt. lower lobe. On a continuous follow up scan, this lesion showed a very aggressive tendency so that the CT-guided lung biopsy was performed to exclude lung cancer. However, as there was no consistent clinical course with the result, she performed the video-assisted thoracic surgery (VATS), wedge resection of Rt. lower lobe. Finally, nontuberculous mycobacterium (NTM) infection was confirmed, not lung cancer, and improved by proper treatment. We report this case for the following reasons: unlike previously reported cases, NTM infection occurred in an unusual situation and uncommon imaging findings similar to lung cancer confused the early diagnosis.

Successful thoracoscopic resection of a large mediastinal angiomyolipoma.

An angiomyolipoma (AML) is a benign mesenchymal tumor characterized by proliferation of mature vessels, smooth muscle, and adipose tissue. AMLs most commonly occur in the kidney but have been reported in a variety of extrarenal sites. Mediastinal AMLs are extremely rare. We herein present a case of a large AML of the mediastinum that was successfully treated by thoracoscopic resection.

When Is the Optimal Timing of the Surgical Treatment for Secondary Spontaneous Pneumothorax?

Objectives The definition of spontaneous pneumothorax is accumulation of air in the pleural space, resulting in dyspnea or chest pain. Unlike primary spontaneous pneumothorax, secondary pneumothorax can be a life-threatening condition and spontaneous healing rate is uncommon. Although surgery is the most effective treatment modality for pneumothorax, surgical management and timing is difficult where there is underlying lung disease and/or medical comorbidities. Prolonged air leakage increases the morbidity and mortality in thoracic surgery. We hypothesized that duration of air leakage before operation may lead to increase in complications. Methods This study is a retrospective review of 155 consecutive patients with air leakage who underwent bullectomy for secondary spontaneous pneumothorax from January 2005 to July 2013. The patients were divided according to the duration of preoperative air leakage. The patients were followed-up until the time of last visit or death. Postoperative morbidity and mortality were assessed and the risk factors for complications were analyzed. Results The median age was 65 years (range, 52-88) with male predominance (96.13%). The median duration of preoperative air leakage was 6 days (range, 1-30). The median surgery time was 90 minutes (range, 25-300) and median hospital stay after operation was 7 days (range, 3-75). Postoperative complications occurred in 38 patients (24.52%) and postoperative recurrence was shown to have occurred in 8 patients (5.16%). With multivariate analysis, risk factors for postoperative complications were: underlying interstitial lung disease and air leakage > 5 days before operation. Conclusion Persistent air leakage was a major surgical indication for pneumothorax. Early surgical treatment reduced postoperative complications for secondary spontaneous pneumothorax.

Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?

BACKGROUND: Patients with small pneumothoraces are usually treated with oxygen therapy. However, evidence that oxygen therapy increases resolution rate is based on small populations with secondary spontaneous pneumothorax. Therefore, this study aimed to confirm whether oxygen therapy increases the resolution rate of primary spontaneous pneumothorax (PSP). METHODS: We retrospectively reviewed records of patients with PSP who had undergone outpatient observation (room air group) and those who were admitted for oxygen therapy (O2 group) between March 2005 and February 2016. The initial chest posteroanterior (PA) radiograph was compared with the last chest PA radiograph before the pneumothorax disappeared. The size of the pneumothorax was measured using the Collins' method. RESULTS: A total of 175 episodes were identified in 160 patients. Of these, 128 episodes (73.1%) occurred in patients in the O2 group. The mean age was 19.24±4.74 years. The mean initial size of the pneumothorax was smaller in the room air group (23.32%±7.00% vs. 20.26%±6.78%, P=0.011). The resolution rate was higher in the O2 group [(4.27%±1.97%) vs. (2.06%±0.97%)/day, P<0.001]. The initial size of the pneumothorax, time interval between radiographs, and use of oxygen therapy were significantly associated with the resolution rate in multivariate analysis. CONCLUSIONS: Oxygen therapy increases the resolution rate of PSP. However, routine use of oxygen therapy in patients with small pneumothoraces should be considered more carefully. Well-controlled prospective studies are required to confirm the indication of oxygen therapy.

Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax?

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been widely used for spontaneous pneumothorax (SP). In recent years, thoracic surgeons have attempted single incision or single port surgery with the development of surgical technology and skills. Theoretically, single port surgery is expected to provide benefits such as less pain and early recovery. The purpose of this study was to determine the benefits of single port surgery in SP. METHODS: The 107 patients with SP who underwent surgery, between July 2013 and May 2015, were reviewed retrospectively. The patients with secondary pneumothorax, who underwent open procedures and lacking of medical records were excluded. Visual analog scale (VAS), paresthesia and clinical outcomes were reviewed in 86 patients (46 patients: three-port, 40 patients: 11.5 mm guided single-port). RESULTS: The mean age was 23.4 years in three-port and 22.4 in single-port (P=0.247). The height and body weight were not significantly difference between two groups. The mean operation time was 39 minutes (mins) in the three-port and 37.3 mins in the single port without statistical difference (P=0.204). The pain score in the single port surgery was significantly lower after postoperative day (POD) 1 (P=0.028). However chest tube duration time was significantly shorter in the single port group (P<0.001). After exclusion of the patients with chest tube removal within postoperative 1 day, the pain score was not significantly different at the POD 1 between two groups (P=0.176). The pain score between two groups were not different at 1 week after discharge. CONCLUSIONS: The pain score reduction was found 1 day after operation in the single port group. However, the chest tube duration time was significantly shorter in the single port group and the pain score was not different at 1 week after discharge. Considering young age in primary SP, the benefit of single port surgery in SP was minimal.

Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy.

BACKGROUND: Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. METHODS: From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. RESULTS: The median age was 19 years (range, 11-34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1-10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. CONCLUSIONS: Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence.

Clinical experience of spontaneous pneumomediastinum: diagnosis and treatment.

BACKGROUND: Spontaneous pneumomediastinum (SPM) is a benign disease with a variety degree of severity but definite treatment modality is not clearly identified with its rarity. The purpose of this study was to review our experience and discuss the management of SPM according to the severity of disease. METHODS: From March 1996 to December 2012, total 64 patients were enrolled and classified as mild, moderate and severe groups and subsequent clinical courses were analyzed retrospectively. RESULTS: Fifty-one were males and 13 were females (M:F =3.9:1) with a mean age of 18 years old (range: 10-30 years old). Thirty-six patients were in mild, 22 in moderate and 6 in severe group. Chief complaints were chest pain (50 cases; 78.1%), neck pain (35 cases; 54.7%), dyspnea (18 cases; 28.1%), odynophagia (9 cases; 14.1%) and precipitating factors were coughing in 12 cases, feeding problems in 9 cases, and vomiting in 7 cases; however, 34 patients (53.1%) had no precipitating signs. All patients received oxygen therapy (100%), prophylactic antibiotics in 57 patients (89.1%), and pain medications in 47 patients (73.4%). The mean hospital stay was 4.6 days (range: 1-10 days). There was an increased linear trend according to time to visit (P=0.023) but clinical course demonstrated no significant trend between groups. CONCLUSIONS: These data demonstrated that there was no difference in symptom, clinical course and SPM was adequately treated with conservative management regardless of the degree of severity of SPM.

Lymphatic vessel invasion in pathologic stage I and II non-small cell lung tumors.

PURPOSE: Tumor node-metastasis staging is essential for predicting the prognosis of patients with non-small cell lung cancer (NSCLC); however, its accuracy remains limited. The aim of this study was to establish the significant predictors of outcome for patients with pathologic stage I or II NSCLC. METHODS: We reviewed the records of patients with pathologic stage I and II NSCLC retrospectively. After the exclusion of those who underwent sublobar resection, received neoadjuvant treatment, or died within 30 days of surgery, 271 patients treated between January, 2004 and December, 2010 were analyzed. We investigated whether lymphatic vessel invasion (LVI) grade was associated with prognosis in stage I or II NSCLC. RESULTS: The median age of the patients was 64 years. Of the 198 and 73 patients with pathologic stage I and stage II disease, respectively, 73 (26.9%) had LVI. Thirteen patients had a high degree of LVI. Although LVI was not associated with overall survival (p = 0.13), a high degree of LVI was associated with poor survival (p < 0.001). Multivariate analysis revealed that diabetes mellitus (p = 0.001), tumor size (p < 0.001), LVI grade (p < 0.001), and pathologic stage II (p = 0.040) were all associated with overall survival. CONCLUSIONS: A higher grade of LVI was predictive of a worse prognosis. Further study is required to establish the prognostic role of moderate and marked LVI in NSCLC.

Prognostic Value of the Maximum Standardized Uptake Value on Positron Emission Tomography for Esophageal Squamous Cell Carcinoma.

BACKGROUND: Esophageal cancer is a malignant tumor with one of the worst prognosis. Positron emission tomography (PET) reveals the degree of metabolic activity of tumor cells. We hypothesized that a high maximum standardized uptake value (SUVmax) on PET would predict a poor clinical outcome. METHODS: From November 2004 to August 2011, we reviewed 88 patients with esophageal squamous cell carcinoma who underwent preoperative PET followed by surgery. SUVmax values of primary sites were measured. The patients were divided into two groups with median SUVmax as a cutoff value and outcomes were compared. RESULTS: The median SUVmax was 6.35. Cervical and upper thoracic cancer, large tumor size, stage ≥ T2, and lymph node metastasis were significantly associated with the high SUVmax group. Cervical and upper thoracic cancer (p = 0.038), SUVmax (p = 0.038), number of lymph nodes dissected (p = 0.009), stage ≥ T2 (p = 0.003), lymph node metastasis (p < 0.001), and incomplete resection (p = 0.031) were significant predictors for the disease-free survival. A high SUVmax ( ≥ 6.35, p = 0.023) and stage ≥ T2 (p = 0.025) were significantly associated with overall survival by multivariate analysis. CONCLUSION: High preoperative SUVmax on PET predicts advanced T stage and worse prognosis. SUVmax on PET may provide useful information combined with current stage for determining optimal treatment in esophageal cancer.

Recurrent intractable hiccups treated by cervical phrenic nerve block under electromyography: report of a case.

Intractable or persistent hiccups require intensive or invasive treatments. The use of a phrenic nerve block or destructive treatment for intractable hiccups has been reported to be a useful and discrete method that might be valuable to patients with this distressing problem and for whom diverse management efforts have failed. We herein report a successful treatment using a removable and adjustable ligature for the phrenic nerve in a patient with recurrent and intractable hiccups, which was employed under the guidance of electromyography.

Prognostic factors affecting survival of patients with cancer-related pericardial effusion managed by surgery.

BACKGROUND: Although pericardial effusion (PE) is not uncommon in patients with cancer, it may lead to cardiac tamponade, a life-threatening condition. Prompt life-saving treatment is essential, and also allows the continuation of the cancer treatment. The aim of this study was to determine the prognostic factors for survival in patients with cancer who were treated surgically for PE. METHODS: We retrospectively reviewed the medical records of 55 patients with cancer with PE between January 2003 and October 2012, who were treated with a pericardial window operation. Overall survival (OS) was estimated from the date of surgery, and patients were followed until the time of the final visit or time of death. Clinical outcomes and candidate prognostic factors were analyzed. RESULTS: The median age of patients was 57 years (range 29 to 82 years), and 31 patients (56.4%) were male. The most common primary malignancy was lung cancer (65.5%), followed by breast cancer (10.9%). Fifteen patients (27.3%) developed recurrence of PE after surgery. The median OS duration was 4 months (range 0 to 39 months). Multivariate analysis found that evidence of pericardial metastasis on preoperative imaging (P = 0.029) and confirmation of malignant cells in the PE and/or pericardial tissue (P = 0.034) were associated with reduced OS. CONCLUSION: Evidence of pericardial metastasis on preoperative imaging and cytopathologic confirmation that the PE and/or pericardial tissue are positive for malignant cells can be used to predict poor clinical outcomes in patients with cancer-related PE.

Intrapulmonary recurrence after computed tomography-guided percutaneous needle biopsy of stage I lung cancer.

Tumor seeding, along the needle tract after percutaneous needle biopsy, is a rare condition and most of the reported cases are implantation metastasis, which occurred in the chest wall or the pleura. We present a case of implantation metastasis that occurred in the pulmonary parenchyma, after a computed tomography-guided percutaneous needle biopsy (CT-PNB) of stage I lung cancer.