Masatarou Hayashi

Independent predictive value of the overall number of metastatic N1 and N2 stations in lung cancer.

OBJECTIVE The number of metastatic N2 stations is a known prognostic factor in patients with non-small-cell lung cancer (NSCLC). However, involvement of N1 stations as well as that of N2 stations seems to be important in the prognosis of these patients. We therefore attempt to clarify the significance of the total number of metastatic stations in pathologic N1 and N2 NSCLCs. METHODS Patients with either pathologic N1 (n = 51) or N2 (n = 96) NSCLC who had undergone major pulmonary resection with complete mediastinal dissection were included in this retrospective study. All positive nodes were characterized by location according to the TNM classification system. The hilar station was included with the N2 stations. RESULTS The total number of metastatic stations in patients with N2 disease ranged from 1 to 8 (average 2.5), whereas that in patients with N1 disease ranged from 1 to 3 (average 1.2). The incidence of multiple-station metastasis (> or = 3 metastatic stations) among N2 patients (35%) was significantly higher than that among N1 patients (2%) (p < 0.001). Multivariate analysis of survival showed pathologic N1 status (relative risk = 0.443, p = 0.013) and < or = 2 metastatic stations (relative risk = 0.515, p = 0.020) to be significant and independent prognostic factors. Age, sex, cell type, resected lobe, and pathological T status were statistically insignificant determinates of survival. CONCLUSIONS The total number of metastatic stations (< or = 2 vs > or = 3) is an independent prognostic indicator in patients with completely resected pathologic N1 or N2 NSCLC. The number of metastatic stations will be useful as a stratification factor in prospective clinical trials of these patients.

Surgically Treated Primary Lung Cancer Associated with Brugada Syndrome : Report of a Case

Abstract A 71-year-old man with primary lung cancer associated with Brugada syndrome was safely oper-ated on following the placement of an implantable cardioverter defibrillator (ICD). During examinations for Brugada syndrome, a tumor in the apicoposterior segment of the left lung was incidentally detected by chest computed tomography. Following the implantation of an ICD, surgical treatment of the left lung tumor was scheduled. A lung biopsy was thoracoscopically performed and adenocarcinoma was diagnosed based on a frozen section analysis. A left upper lobectomy with lymph node dissection was performed through a standard posterolateral thoracotomy. Ventricular fibrillation, which occurred during the night of the first day following surgery, was successfully managed by the ICD.

Minimally invasive treatment for spontaneous mediastinal hematoma.

To the Editors: Spontaneous mediastinal hematoma is a rare event with an indistinct clinical presentation. It is treated conventionally by complete resection via sternotomy or open thoracotomy. We report our initial experience of treating 2 patients successfully via port-access thoracoscopic surgery. Patient 1. A 34-year-old man with idiopathic thrombocytopenic purpura (ITP), who had recently become unresponsive to steroid treatment, was admitted with a 3-day history of left chest and back pain and breathlessexamination revealed a cyst with inflammation and hemorrhage in fat tissue. No evidence of tumor tissue was observed. A CT scan performed 3 months after the operation confirmed almost complete disappearance of the hematoma (Fig 1, B). Patient 2. A 40-year-old man was admitted for investigation of chest tightness, anemia, and left hemothorax. He had suffered from a severe cough 3 weeks before admission and denied having sustained any trauma to his chest. He was not taking any anticoagulant therapy and had no sign of disease that caused bleeding tendency. Dynamic CT showed a posterior mediastinal mass that surrounded the thoracic descending aorta, which mimicked an aortic aneurysm or mediasti-

Diclofenac (voltaren)-induced pneumonitis after chest operation

We report a rare case of nonsteroidal anti-inflammatory drug-induced pneumonitis in a 72-year-old man taking diclofenac for wound pain after pulmonary resection. The pneumonitis and pleural effusion were predominant on the operative side and resolved rapidly after the diclofenac was discontinued. The diagnosis of drug-induced pneumonitis was based on a lymphocyte stimulation test that was positive for diclofenac sodium and negative for other drugs. This case report demonstrated that surgeons should be aware of the possibility of pneumonitis induced by a nonsteroidal anti-inflammatory drug.