Mitsuharu Kokubo

Lung perfusion SPECT in predicting postoperative pulmonary function in lung cancer

The aim of this prospective study is to evaluate the availability of preoperative perfusion SPECT in predicting postoperative pulmonary function following resection. Twenty-three patients with lung cancer who were candidates for lobectomy were investigated preoperatively with spirometry, x-ray computed tomography and99mTc macroaggregated albumin SPECT. Their postoperative pulmonary functions were predicted with these examinations. The forced vital capacity and the forced expiratory volume in one second were selected as parameters for overall pulmonary function. The postoperative pulmonary function was predicted by the following formula: Predicted postoperative value=observed preoperative value × precent perfusion of the lung not to be resected. The patients were reinvestigated with spirometry at 3 months and 6 months after lobectomy, and the values obtained were statistically compared with the predicted values. Close relationships were found between predicted and observed forced vital capacity (r=0.87, p < 0.001), and predicted and observed forced expiratory volume in one second (r=0.90, p < 0.001). The accurate prediction of pulmonary function after lobectomy could be achieved by means of lung perfusion SPECT.

Prediction of Pulmonary Function After Resection of Primary Lung Cancer: Utility of Inhalation-perfusion Spect Imaging

To help determine whether preoperative perfusion and inhalation SPECT imagings are useful in predicting postoperative lung function, Tc-99m MAA perfusion SPECT imaging, CT scans, and pulmonary function tests were prospectively performed in 33 patients with primary lung cancer before and after lobectomy or pneumonectomy. Tc-99m Technegas inhalation SPECT imaging was performed in 6 of 33 patients as well. The authors also studied changes in radioactivity on the operated and nonoperated sides before and after surgery, examined the lowest limit value for adaptability to the operation, and made a comparison of both perfusion and inhalation SPECT imaging. The predicted postoperative values obtained from the preoperative Tc-99m MAA SPECT images correlated more closely with the measured 6-month postoperative values than with the measured 3-month postoperative values. The highest correlation coefficient (r = 0.86) was observed between the predicted forced vital capacity (FVC) value and the measured 6-month postoperative FVC value. In many cases, there was not a great difference between the 6-month and 3-month radioactivity on the operated side obtained from Tc-99m MAA SPECT images. This appears to indicate that pulmonary blood flow on the operated side has completely recovered by 3 months after surgery. However, radioactivity in both the upper and lower lobes of the nonoperated side increased soon after surgery compared with that before the operation, and had not returned to preoperative levels 6 months after surgery. The radioactivity in the right middle lobe did not change before and after surgery. The lowest limit value for adaptability to the operation was estimated to be 1.1 L for FVC and 900 ml for forced expiratory volume (FEV)1.0. The predicted values obtained from both perfusion and inhalation SPECT studies closely approximated each other, making it difficult to determine which SPECT imaging was superior.

Multiple chondromatous hamartomas of the lung

Multiple chondromatous hamartomas of the lung, which are very rare, are a feature of Carney syndrome. The relation between the two entities is not clear.

Endobronchial Spread of Parenchymal Metastases

We are pleased that Drs. Golpe and Mateos found our article of interest and that they had similar findings in their smaller study. Their study confirms that transient minor desaturation is common during bronchoscopy, but we differ in our response to this finding. We are unaware of any reports of adverse consequences from transient minor desaturation of the type described in both articles. Therefore, any recommendation to administer oxygen to all patients during flexible bronchoscopy must be regarded as a non–evidence-based suggestion. Golpe and Mateos have also reported minor desaturation after the bronchoscopy procedure, and they suggest that oxygen treatment should be continued for an unspecified time after the procedure. This would increase the cost and complexity of running a bronchoscopy service (our present practice is to continue oxygen treatment after bronchoscopy only if oximetry indicates hypoxia following the procedure). The significance of transient mild desaturation (mean SD arterial oxygen saturation, 91 3%) during the recovery phase is of very uncertain significance. The patients had no instrumentation during this phase. For example, it is known that patients with moderate COPD but normal resting oxygen saturation can have significant hypoxia develop at an oxygen pressure equal to that of a commercial airliner, with a further fall to a mean saturation of 80% during mild exercise.1 These patients were all asymptomatic, and it has never been suggested that COPD patients with normal resting blood gas should be administered oxygen during flight. We are confident about the safety of our present practice of administering oxygen only to patients who have sustained hypoxia develop (or to those with high-risk features, such as angina).

A Case of Pulmonary MALT Lymphoma with Pericardial Invasion 5 Years after Diagnosis of Pseudolymphoma of the Lung.

従来, 肺pseudolymphomaとされた症例の多くはIsaacsonが1983年以来提唱している粘膜関連リンパ組織 (mucosa-associated lymphoid tissue;MALT) に由来する低悪性度B細胞リンパ腫 (MALT型リンパ腫, MALT lymphoma) であると考えられている.今回, われわれは肺pseudolymphomaとして5年半経過観察したMALT型肺リンパ腫を経験した.本症例は病理学的検査および免疫組織検査にて明らかなMALT型リンパ腫の所見を有していた.また心膜外脂肪組織にも浸潤していた.周囲に浸潤したMALT型肺リンパ腫は稀であり報告する