Extrapleural hematoma as a complication following thoracotomy for pulmonary lobectomy.

Extrapleural hematoma as a complication following thoracic surgery is rare. We report a case of an extrapleural hematoma following pleural lobectomy that resolved completely with nonsurgical treatment. A 63-year-old woman underwent left lower lobectomy for lung cancer through a left posterolateral thoracotomy. She had been prescribed the anticoagulant cilostazol to increase her heart rate for atrioventricular dissociation. Preoperatively, it was stopped, and a temporary pacemaker was placed to counteract bradycardia via the right jugular vein without complication. The chest tube was removed, and cilostazol was resumed on the third postoperative day. On day 7, she suddenly experienced left shoulder pain followed by hypotension, tachycardia, and anemia. Enhanced computed tomography (CT) revealed an extrapleural hematoma rather than a hemothorax. She became symptomatic after rapid infusion. The hematoma resolved without an invasive intervention. The CT results 189 days after the onset showed almost complete regression of the hematoma.

A case of primary pulmonary hypertension with pulmonary tumor.

A 64-year-old female with a 9-year history of primary pulmonary hypertension developed a solid pulmonary tumor. Partial lung resection was planned for diagnosis. Although prostacyclin was increased to 8 ng/kg/min, she did not tolerate the decubitus position and one-lung ventilation, and her pulmonary arterial pressure rose to 110/45 mmHg. While she underwent partial resection under two-lung ventilation in the decubitus position, bleeding occurred from the suture line closed by a linear stapler and was controlled by additional sutures. She was discharged home without postoperative complications on postoperative day 15. The pathological examination revealed a bronchioloalveolar carcinoma. If pulmonary resection becomes necessary in a similar patient, we will plan a partial resection with the patient in a supine position to prevent elevation of pulmonary arterial pressure.

Trichostatin A with adenovirus-mediated p53 gene transfer synergistically induces apoptosis in breast cancer cell line MDA-MB-231.

Although the p53 anti-oncogene is an important target for gene therapy of cancer, some cancers are resistant to p53 gene transfer. For this reason, it is important to find effective drugs to enhance cytotoxic effects of p53 gene transfer. Recent reports demonstrated that some histone deacetylase inhibitors in combination with p53 gene therapy induced apoptosis in certain cancer cells more efficiently than p53 gene therapy alone. We investigated whether histone deacetylase inhibitor trichostatin A (TSA), in combination with p53 gene transfer could synergistically induce apoptosis in the breast cancer cell line MDA-MB-231. Whereas the adenovirus-expressing p53 (Ad-p53) by itself at up to 100 multiplicity of infection (MOI) induced apoptosis at a low level, Ad-p53 in combination with TSA synergistically induced apoptosis at a higher level in MDA-MB-231 cells than TSA or Ad-p53 alone. However, the combination of Ad-p53 and TSA did not enhance the expressions of p53 or p53-induced genes that are involved in apoptosis, and synergistically reduced the mitochondrial membrane potential and enhanced caspase-3 activity. These results suggest that TSA have synergistic effects on the induction of apoptosis in MDA-MB-231 cells when combined with p53 gene transfer.

Simultaneous resection of bilateral intralobar and extralobar pulmonary sequestrations with video-assisted thoracoscopic surgery.

The term pulmonary sequestration is applied to a pulmonary lobe or portion of a lobe that is supplied by an anomalous systemic artery and drain either into the systemic or pulmonary veins. The conditions are divided into intralobar pulmonary sequestration, in which the sequestration is situated inside the visceral pleura of a normal lobe, and extralobar sequestration, in which the sequestration is surrounded by its own pleura. Most sequestrations are unilateral; bilateral sequestrations are rare. We report the case of a synchronous bilateral intralobar and extralobar pulmonary sequestrations resected simultaneously with video-assisted thoracoscopic surgery.

Survival and prognostic factors in resected cN2-pN0 non-small cell lung cancer.

This study retrospectively examined the records of patients with clinical N2 (cN2) stage non-small cell lung cancer (NSCLC) who were surgically treated but who actually had pathologic N0 (pN0) stage disease. From 1982 to 1997, 94 patients with cN2 NSCLC underwent surgery. Forty-five patients proved to have pN0 disease, with an overall 5-year survival rate of 67.3%. According to the Cox model, visceral pleural invasion (p=0.01) and a carcinoembryonic antigen (CEA) concentration > or =2.5 ng/mL (p=0.03) negatively influenced survival. The six patients with both visceral pleural involvement and a CEA > or =2.5 ng/mL all died within five years compared with a 78.1% 5-year survival for the 21 patients who had neither factor. For the subgroup of patients who have poor prognostic factors, multimodality therapy should be considered. Our previous report found that parietal pleural invasion, elevated CEA concentration, and the number of involved mediastinal lymph node (MLN) stations correlated with survival in 40 patients with cN2-pN2 disease who underwent resection. These data show how important it is to assess pleural status carefully and measure the CEA concentration, as is to determine the MLN status in patients with cN2 disease.