Kiyohiro Fujiwara

Surgery for pulmonary metastases from colorectal carcinoma

BACKGROUND This study aims to clarify which patients would benefit by surgery for pulmonary metastases from colorectal carcinoma. METHODS A retrospective study was undertaken in 25 patients who had undergone complete resection. In all cases, prethoracotomy carcinoembryonic antigen (CEA) level was measured and mediastinal or hilar lymph nodes were histologically examined. RESULTS Overall 5-year survival was 39.2%. The 5-year survival rate for patients with a normal CEA level was 61.1%, as compared with 19.0% for patients with an elevated CEA level (p = 0.0423). The 5-year survival rate for patients without a lymph node metastasis was 49.5%, as compared with 14.3% for patients with a lymph node metastasis (p = 0.0032). No lymph node metastasis was a predictor of longer survival by univariate and multivariate analyses. The primary site, disease-free interval, and number and size of the metastasis were not significant prognostic factors. CONCLUSIONS A resection for pulmonary metastasis from colorectal carcinoma is effective in patients with a normal CEA level and without a lymph node metastasis.

Results of preoperative mediastinoscopy for small cell lung cancer

BACKGROUND The significance of mediastinoscopy for small cell lung cancer is unclear owing to the small number of surgical cases. METHODS To determine the N component of the TNM staging system, computed tomographic findings and the results of mediastinoscopy were compared with the pathologic examination of surgical specimens. RESULTS Four cases among 37 patients (10.8%) were determined as inoperable by mediastinoscopy because of mediastinal lymph node metastasis. A thoracotomy was performed in 33 patients. Six patients (18.2%) who had been judged to have no metastasis by mediastinoscopy were found to have N2 disease after examination of the surgical specimens. In the identification of all mediastinal metastases, mediastinoscopy was 40.0% sensitive, 100% specific, and 83.8% accurate. When the superior mediastinal, paratracheal, pretracheal, tracheobronchial, and subcarinal lymph nodes were defined as approachable nodes, mediastinoscopy was 66.7% sensitive, 100% specific, and 94.6% accurate in the evaluation of these restricted nodes. Four cases among 8 patients with cN1 lesions resulted in a designation as pN2. CONCLUSIONS Mediastinoscopy is useful for the diagnosis of an approachable mediastinal lymph node in small cell lung cancer cases. This exploration is necessary for patients with small cell lung cancer who are diagnosed as cN1 before thoracotomy.

Steroid therapy without primary dose escalation for postthymectomy crisis in 2 thymomatous myasthenia gravis patients

We report 2 cases of thymomatous myasthenia gravis associated with postoperative crisis and medicated with steroid therapy using prednisolone without primary dose escalation. Two women, a 38 years old and the other 64 years old, underwent extended thymectomy under the diagnosis of myasthenia gravis associated with invasive thymoma. Bulbar symptoms in both were severe despite preoperative anticholinesterase medication. Myasthenic crises with an antiacetylcholine receptor antibody (anti-AchR Ab) elevation were encountered in the postoperative clinical course. Daily administrations of a large amount of prednisolone without primary dose escalation and the subsequent tapering therapy effectively improved myasthenic symptoms and decreased their anti-AchR Ab titer. We also discuss difficulties in treatment in these cases.