Efficacy and long-term clinical outcome of bronchial occlusion with endobronchial Watanabe spigots for persistent air leaks.

BACKGROUND: We reviewed our clinical experience and examined the efficacy and long-term outcome of bronchial occlusion with endobronchial Watanabe spigots (EWSs). METHODS: We retrospectively reviewed the clinical charts of patients who had undergone endoscopic bronchial occlusion with EWSs between July 2002 and July 2004. The affected bronchi were identified by chest computed tomography, pleurography, and balloon occlusion test. RESULTS: Of the 21 patients, 18 had underlying pulmonary complications, including chronic obstructive lung disease (n=14), cancer (n=4), pneumoconiosis (n=3), and pneumonia (n=1). Six (29%) achieved complete resolution and 12 (57%) experienced a reduction in air leaks after the first EWS insertion. Of the 12 patients with reduced air leaks, 10 subsequently underwent chemical pleurodesis and 5 (24%) achieved complete resolution after the procedure. A second EWS insertion procedure was performed for 8 patients: 2 achieved complete resolution and 5 achieved a further reduction in air leaks with complete resolution after chemical pleurodesis. Eighteen of the 21 patients were followed up at an outpatient clinic after discharge: 13 for more than 12 months and 4 for more than 84 months. During the follow-up period, most patients did not show any obvious pulmonary complications. CONCLUSIONS: We showed that bronchial occlusion with EWSs was effective in stopping or reducing air leaks and that 86% of our patients finally achieved complete resolution, some when the occlusion was combined with chemical pleurodesis. The rate of complications was acceptable, even after long-term placement.

Novel mutation (L157X) in the succinate dehydrogenase B gene (SDHB) in a Japanese family with abdominal paraganglioma following lung metastasis.

Recently, nuclear genes encoding two mitochondrial complex II subunit proteins, SDHD and SDHB, have been found to be associated with the development of familial pheochromocytomas and paragangliomas (hereditary pheochromocytoma/paraganglioma syndrome: HPPS). Growing evidence suggests that the mutation of SDHB is highly associated with abdominal paraganglioma and the following distant metastasis (malignant paraganglioma). In the present study, we report the case of a novel SDHB mutation (L157X) in a Japanese patient with abdominal paraganglioma following malignant lung metastasis. In addition, we identified an asymptomatic carrier of the SDHB mutation in this family.

Preoperative steroid therapy stabilizes postoperative respiratory conditions in myasthenia gravis.

OBJECTIVE: We reviewed our experience from 1990 to 2005 to examine whether control of myasthenia gravis (MG) with steroid therapy before surgery could stabilize postoperative respiratory conditions, compared with the nonsteroid treatment. METHODS: Records of 43 consecutive patients with MG who underwent extended thymectomy at Kansai Medical University Hospital were retrospectively reviewed. Two groups, a steroid group (n = 28) and a nonsteroid group (n = 15) were compared. RESULTS: In the steroid group, steroid doses ranged from 10 to 100 mg every other day, or 40-60 mg daily. The patients showed significantly less thymus hyperplasia in the pathological findings (P = 0.023). Whereas 3 of 28 (7%) in the steroid group suffered respiratory insufficiency within 3 days of surgery, 5 of 15 (33%) in the nonsteroid group exhibited the same problem (P = 0.030). Univariate analysis showed that steroid treatment was the only significant factor (P = 0.041) affecting respiratory insufficiency. Patients in the steroid group achieved palliation of MG more quickly after surgery than patients in the nonsteroid group (86% vs. 57% within 6 months, P = 0.059; 84% vs. 42% within 1 year, P = 0.042). CONCLUSION: The control of myasthenia gravis with steroid therapy before surgery seems to stabilize postoperative respiratory status without having adverse effects on surgical infection.

Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients.

OBJECTIVES: The aim of this study was to determine whether walking at 4 h after surgery as a more aggressive way to proceed with early mobilization could be a safe approach compared with the patients who walked the day after surgery. METHODS: We encouraged patients who had lobectomy for non-small-cell lung cancer at Kansai Medical University Hospital to walk at 4 h after surgery and start pulmonary rehabilitation between January 2003 and June 2005. A group of 36 patients walked at 4 h after surgery. We retrospectively reviewed the postoperative courses of the patients and compared them with 50 patients who walked the next day during the same period. RESULTS: No patient had major trouble with chest drainage tube, and no patients fell when walking at 4 h. Amount of drainage, changing rates of the heart load during the walking, and pain scores after walking did not show significant differences in patients walking at 4 h and those walking the next day. Although four patients who walked the next day had an arterial oxygen partial pressure/inspired oxygen concentration ratio of <300 on day 3, none in the patients walking at 4 h had a ratio below this level. Among the patients walking at 4 h, 24 (67%) needed oxygenation for less than 2 days compared with 17 (34%) of the patients walking the next day. CONCLUSION: Walking at 4 h after lobectomy in patients with non-small-cell lung cancers is a safe approach to starting pulmonary rehabilitation after surgery.

Bilaterally repeated spontaneous pneumothorax with ankylosing spondylitis.

Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the joints of the axial skeleton. Pleuropulmonary involvement is an uncommon, late event in the course. A 53-year-old man who had a diagnosis of ankylosing spondylitis since he was 40 years old developed a bilaterally repeated and refractory spontaneous pneumothorax. He was treated successfully with surgery to the left pneumothorax that had been refractory to conservative chest tube drainage and chemical pleurodesis. During the second episode of right-side pneumothorax, he developed severe respiratory insufficiency because of his coexisting restrictive lung disease. He was successfully treated with chemical pleurodesis to the right pneumothorax. In our experience, prophylactic treatment such as surgery and pleurodesis should be considered for patients with ankylosing spondylitis during the first episode of pneumothorax.

New tubular bioabsorbable knitted airway stent: feasibility assessment for delivery and deployment in a dog model.

PURPOSE: The aim of this study was to determine whether it is possible to deliver and deploy a new device, a poly-L-lactic acid (PLLA) tubular knitted airway stent, under bronchoscopic guidance in a dog model. DESCRIPTION: The delivery system consisted of a flexible balloon catheter (controlled radial expansion balloon dilator, M00558440, Boston Scientific Corporation, MA, USA) preloaded with a stent. A delivery catheter preloaded with a stent was advanced to a target point in the trachea under bronchoscopic guidance. Once the stent was positioned, the balloon was inflated for sixty seconds. The stent was in full contact with the tracheal wall upon deflation of the balloon. EVALUATION: The stents were successfully delivered into the tracheal lumen and successfully deployed in all dogs. CONCLUSIONS: This is the first study to prove the feasibility of delivering and deploying the PLLA stents in a dog model, using a balloon expansion technique. Further investigation with large numbers of subjects and long-term follow-up will be necessary to assess the utility of the bioabsorbable knitted tubular stent before clinical applications begin.

Prognostic significance of p53, Ki-67, VEGF and Glut-1 in resected stage I adenocarcinoma of the lung.

OBJECTIVES: The purpose of this study was to evaluate the prognostic significance of various biological factors in patients with resected stage I adenocarcinoma. METHODS: We immunohistochemically examined 47 specimens of surgically resected adenocarcinomas to evaluate the expression of the biological markers p53, Ki-67, vascular endothelial growth factor (VEGF) and glucose transporter-1 (Glut-1). Angiogenesis grade and tumor vessel invasion was also investigated. Actuarial survival was analyzed by the Kaplan-Meier method. Clinical variables and biological markers were analyzed using the Cox's proportional hazards model for multivariate analysis to identify independent prognostic factors. RESULTS: The overall survival rate for the whole series was 85.1% at 3 years and 71.9% at 5 years, with a median survival time of 73 months. Differentiation, Ki-67, Glut-1, VEGF, tumor vessel invasion and microvessel density (MVD) were significant prognostic factors by univariate analysis, with Glut-1 expression the most important prognostic factor for survival (P<0.0001). After multivariate analysis, only Glut-1 expression remained as a prognostic factor for survival. CONCLUSION: Glut-1 expression can be a predictor for prognosis in patients with resected stage I adenocarcinoma of the lung.

A new bioabsorbable sleeve for staple-line reinforcement: report of a clinical experience.

PURPOSE: The most frequent and troublesome complication after resection of an emphysematous lung is persistent air leakage. This report describes our recent experience of using sleeves made of polyglycolic acid to reinforce staple-lines to reduce air leaks after resection of emphysematous lung. METHODS: We used bioabsorbable sleeves made of polyglycolic acid (PGA) for staple-line reinforcement during lung resections in 25 patients with emphysema. RESULTS: Immediately after stapling, no air leaks were detected in 20 patients (80%), although prolonged air leaks lasting for more than 7 days were observed in three patients (12.5%). CONCLUSION: PGA sleeves do not constitute a foreign body that stays in the host lung, and they require no rinsing at the time of clinical use. Therefore, the PGA sleeve could be a promising new material instead of non-absorbable materials and xenomaterials for staple-line reinforcement.