[Computed tomography (CT) assessment of the postoperative change of pericardial fat pad used in pulmonary surgery].

The purpose of this study is to clarify the postoperative change of pericardial fat pad used in pulmonary resection to reinforce bronchial suture or bronchial stump. 5 cases who received chest computed tomography (CT) examination 2 times or more after the operation (once within one week after the operation) were enrolled. For evaluation, scoring system from 1 to 4 according to the percentage of remaining pericardial fat pad was applied(1 point: 0∼19%, 2 point: 20∼49%, 3 point: 50∼79%, 4 point: 80∼100%). At 1 to 2 months after the operation, almost all cases were 3 or 4 point. However, the scores declined to 1 or 2 point 5 months after the operation in almost all cases. It is likely that the pericardial fat pad remains to be effective in protecting bronchial stump or anastomosis 1 to 2 months after the operation.

[Examination of a relapsing pattern of cases of completely resected non-small cell lung cancer].

PURPOSE: The purpose of this research was to understand the clinical discovery of a relapse, relapse time, and the presentation of the first relapse of non-small cell lung cancer(NSCLC)by examining cases of relapse after complete resection of NSCLC. Objective and method. Cases of relapse after complete resection of NSCLC in our hospital were examined. RESULTS: Fifteen cases were evaluated. In half of these cases, relapse was discovered owing to increased tumor marker values. Of the patients, 60%had a relapse within 2 years after resection and 20%had a relapse 5 years after resection. The first relapse was a local recurrence in 9 cases, lung metastasis in 5 cases, and distant metastasis outside the thoracic cavity in 3 cases. CONCLUSION: The effectiveness of the tumor marker as a diagnostic parameter of relapse in NSCLC was demonstrated. Discovering distant metastases at the early postoperative period and relapse 5 years after resection are important.

[Examination of clinical presentation in terminal-phase lung cancer patients at a single palliative care unit].

OBJECTIVE: To study the clinical presentation of lung cancer patients at our palliative care unit (PCU). DESIGN: We examined the clinical presentation of lung cancer patients at our PCU and compared it with the clinical presentation of patients with malignant tumors besides those indicative of lung cancer. RESULTS: The PCU occupancy ratio of lung cancer patients to inpatients was 24%, which was dependent on the type of carcinoma. Lung cancer patients in need of oxygen inhalation and/or terminal sedation were more in number than those with other types of malignant tumors. On the other hand, few patients needed treatment. Dyspnea is the major reason for the terminal sedation of lung cancer patients. CONCLUSION: Severe dyspnea appeared to be the typical clinical presentation of terminal-phase lung cancer patients.

[Pulmonary resection for lung cancer in a patient with an anomalous course of the right apical pulmonary vein].

We carried out right upper lobectomy and mediastinal node dissection for a 67-year-old man with lung adenocaricinoma in the right upper lobe. Intraoperatively, we found the middle lobe vein, V2, and V3 in front of the pulmonary hilum, and did not found a part of the right apical pulmonary vein. We found a part of the right apical pulmonary vein placed between the right main pulmonary artery and the right upper lobe bronchus, after cutting the pulmonary artery branches to the right upper lobe. We should keep on mind the possibility of anomalous course of pulmonary vein when pulmonary surgery is planned. And, if this abnormality is doubted with the preoperative chest computed tomogrphy (CT) scan, threedimensional CT( 3D-CT) scan of the pulmonary vein is useful.

[Examination and care for cancer patients with difficult-to-assess pain - feed back on patients who received consultation from our palliative care team].

OBJECTIVE: The care of cancer patients whose pain is difficult to assess is examined. METHODS: Cancer patients who received a consultation because pain assessment by our palliative care team between September 2008 and November 2010 proved difficult, were evaluated retrospectively. RESULTS: The corresponding cases were five cases(5. 6% of all cases who received consultation). The cause of the difficulty in the assessment of pain was due to dementia in two cases, mental retardation in one case, the patient's personality in another case, and the patient's believing in a third case. Useful observable items have been pointed out for difficult pain evaluation are of the patient, including expression and behavior. And the importance of chose consideration of the causes of difficult assessment of pain have also been pointed out. CONCLUSION: Careful care according to the cause of the difficult assessment of pain and individual communication ability proved important.

[Retrospective investigation of clinical presentation of lung cancer patients before and after treatment discontinuation].

INTRODUCTION: There is no clear answer as to how long we should continue aggressive treatment for progressive lung cancer. PURPOSE: An ideal way to conduct and discontinue aggressive treatment was examined from the viewpoint of quality of life and the remaining lifespan after treatment discontinuation. MATERIAL & METHODS: We began systemic chemotherapy and/or radiotherapy from January 2003 to December 2007, based on our pathological diagnosis of lung cancer. Then, in 30 patients who thereafter stopped aggressive treatment, we retrospectively investigated the content and period of aggressive treatment, and clinical presentation before and after they discontinued their treatment. In addition, the factors important for quality of life and the prognosis after the treatment discontinuation were analyzed. RESULT: For quality of life and the remaining lifespan after the treatment discontinuation, it was found important to avoid serious adverse effects of treatment and watch out for performance status decrease during the treatment period. Then, after the treatment discontinuation, it was thought to be important to pay attention not only to the cancer progression but also the complications arising from other diseases including pneumonia.

[Clinical evaluation of lung cancer patients with only best supportive care].

Eighteen cases with only symptomatically treated lung cancer admitted to our hospital from May 2002 to October 2006 were retrospectively investigated clinically. The patients consisted of 10 males and 8 females, aged 50-9 8 years old (mean age 78.1 yo). Clinical stage distribution revealed a higher incidence in the advanced stages. The performance status according to the ECOG classification was predominantly grade 2-4. The average survival time was 5.9 4 months. The cell type was the major prognosticator followed by clinical stage and age. There was a tendency to die early in any case that had a poor whole-body state, such as weight reduction and a feeling of whole body fatigue. There was a tendency for the at home period to be short in cases that required control of pleural effusion, and the survival period was short.