Motoki Sakuraba

DIAGNOSTIC VALUE OF THORACOSCOPIC PLEURAL BIOPSY FOR PLEURISY UNDER LOCAL ANAESTHESIA

Background:  We find pleural effusion in clinical practice frequently. However, it is difficult to make a diagnosis definitively by thoracocentesis or closed pleural biopsy. We directly examine the thoracic cavity by thoracoscopy under local anaesthesia, carry out pleural biopsy and make a definitive pathological diagnosis in pleurisy.

Use of silicone gel sheets for prevention of keloid scars after median sternotomy

PurposeA keloid scar often appears at the incision site of patients after median sternotomy. Use of silicone gel to treat hypertrophic burn scars and fresh incisions has yielded encouraging results. In this study, we report our experience with the preventive use of silicone gel sheets for keloid scars after median sternotomy.MethodsNine patients who underwent a median sternotomy were studied. A silicone gel sheet was kept directly on the surgical incision for 24 h starting 2 weeks after surgery. The treatment was repeated with a new sheet every 4 weeks for 24 weeks, at which times the subjective symptoms and the changes in keloid scars were determined.ResultsNone of the patients experienced an aggravation of any subjective symptoms during the 24-week study. After 24 weeks, all patients were free of a keloid scar that showed a rise and contraction of skin and causes discomfort. No adverse events were reported by any of the patients.ConclusionA silicone gel sheet is safe and effective for the preventing the formation of keloid scars after median sternotomy.

Wallstent endovascular prosthesis for the treatment of superior vena cava syndrome.

OBJECTIVE We assessed the clinical outcome of self-expanding Wallstent endovascular prosthesis in the treatment of superior vena cava syndrome due to malignant tumors. METHODS Eleven patients with malignant superior vena cava syndrome were treated by percutaneous implantation of the self-expanding Wallstent endovascular prosthesis across the stricture site. Patency was defined by the absence of symptoms and signs of superior vena cava syndrome. RESULTS Ten of the 11 experienced complete symptomatic relief within 3 days of stent implantation. The remaining 1 did not benefit, and required a second procedure, dying of heart failure 5 days after stent implantation. Ten patients remain symptomatically free of superior vena cava syndrome to date or until death in follow-up lasting 17 to 227 days. CONCLUSION Implantation of the self-expanding Wallstent endovascular prosthesis for malignant superior vena cava syndrome provides rapid symptomatic relief and improves the patients quality of life.

The Impact of Cigarette Smoking on Prognosis in Small Adenocarcinomas of the Lung: The Association Between Histologic Subtype and Smoking Status

Objective: In this retrospective study, we clarified the impact of smoking on prognosis and the association of clinicopathological factors, particularly histologic subtype, in patients with small adenocarcinoma of the lung. Methods: Between 1996 and December 2006, 121 patients presenting with adenocarcinomas that had a diameter ≤2 cm were analyzed. The clinicopathological records of the patients were examined for age, gender, nodal status (c-N and p-N), tumor size, serum carcinoembryonic antigen level, histologic subtype, and smoking history. A histologic subtype was defined using a modified World Health Organization classification. These subtypes are bronchioloalveolar carcinoma (BAC), adenocarcinoma with little or no BAC component (Non or min BAC), and mixed bronchioloalveolar carcinoma with other adenocarcinoma components. Results: The overall 5-year survival rates were 94.4% for never-smokers (N = 55) and 79.2% for smokers (N = 66) (p = 0.05). Cancer-specific 5-year survival rates were 98.0% for never-smokers and 80.4% for smokers (p = 0.03). Gender, serum carcinoembryonic antigen level, and histologic subtype were significantly associated with smoking status. Histologic subtype (Non or min BAC) was the only significant prognostic factor in multivariate analyses. The prevalence of smoking by histologic subtype was 27.3% for BAC, 43.2% for mixed bronchioloalveolar carcinoma, and 74.6% for Non or min BAC. The prevalence was significantly higher in Non or min BAC than in the others. Furthermore, the smoking index (daily cigarette consumption times years of smoking) was significantly higher in Non or min BAC than in the other two subtypes. In addition, patients with a high smoking index showed a greater percentage of Non or min BAC subtypes. Finally, male gender was associated with Non or min BAC independent of smoking status (p = 0.03). Conclusions: When adenocarcinomas were small (diameter ≤2 cm) cigarette smoking and male gender were associated with Non or min BAC histologic subtypes, which are thought to have more aggressive biologic features resulting in poorer outcome compared with other subtypes.

Malignant pericardial mesothelioma

A 72-year-old female, who had no asbestos exposure, felt chest pain. She was diagnosed with pericarditis. After 6 months, a follow-up chest computed tomography (CT) showed a thickened pericardium (Fig. 1(A) and (B)) and a positron emission tomography (PET) scan was positive along the pericardium (Fig. 1(C)). An open pericardial biopsy proved malignant pericardial mesothelioma (Fig. 2). www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 39 (2011) 420

Experience of silicone gel sheets for patients with keloid scars after median sternotomy

PurposeIt is often difficult to control hypertrophic scars and keloids with drug therapy, steroid injection, surgery, radiation therapy, laser, or wound pressing. Use of silicone gel to treat hypertrophic burn scars and fresh incisions has yielded encouraging results. We report our experience of silicone gel sheets for patients with keloids following median sternotomy.MethodsNine patients underwent a median sternotomy and received other therapies before participating in this treatment. A silicone gel sheet was placed directly on the keloid scar and maintained at all times. Sheets were replaced every 4 weeks for a total treatment duration of 24 weeks. The scar area was measured, and subjective symptoms were determined prior to therapy and after completion of therapy.ResultsThere were three men and six women, with a mean age of 45.2 years (range 22–69 years). Progression of protuberance and rub was seen in one patient. Scar redness and cramping were either diminished or unchanged in all patients. Itching progressed in two patients. After 6 months, the area of the scar relative to its initial area was 0.98 (range 0.78–1.27). Harmful events did not occur.ConclusionA silicone gel sheet is effective for treating keloid scars following median sternotomy. Silicone gel sheets are safe and easy to use and do not aggravate any subjective symptoms.

Clinicopathological Factors Associated with Unexpected N3 in Patients with Mediastinal Lymph Node Involvement

Introduction: We have already shown that postoperative survival was poor in p-N3 patients from the experience of extended radical nodal dissection (ERD: cervical and bilateral mediastinal nodal dissection) for lung cancer. In this retrospective study, we aimed to clarify the clinicopathological factors associated with p-N3 in patients with mediastinal lymph node involvement (excluding c-N3) who underwent ERD, and we studied their impact on prognosis. Methods: Between 1996 and April 2006, in patients with lung cancer in the right upper lobe, we performed ERD after obtaining informed consent from the patients. The study comprised 8 females and 29 males (median age of 60 years), with 15/7/15 cases of c-N0/c-N1/c-N2, respectively. The clinicopathological records of each patient were examined for prognostic factors associated with p-N3, including age, gender, histology, c-N number, preoperative serum CEA level, number of metastatic stations, and distribution of metastatic nodes according to the system of Naruke et al. Because c-N3 cases were excluded from the study, we defined p-N3 as unexpected N3. Results: Of the 37 study subjects, 19 (51.4%) had one or more metastases to the mediastinal lymph nodes. Of these 19 patients, 10 (52.6%) had metastases to cervical and/or contralateral mediastinal lymph nodes (unexpected N3; 5-year survival was 0%). C-N factor (c-N2), nonskip N2, multistation mediastinal lymph node metastasis, highest mediastinal nodal involvement, and pT status were significantly associated with unexpected N3. In particular, multistation mediastinal lymph node metastasis and highest mediastinal nodal involvement were significant prognostic factors in multivariate analyses. Conclusions: Because unexpected N3 patients showed a poor prognosis after ERD, treatment modalities other than surgery should be considered. On the other hand, because true N2 patients showed a good outcome after surgery, surgical resection may be considered an important therapeutic modality even for N2 patients, given that they show single-station mediastinal nodal involvement or c-N0-1.

Nitinol stent for the treatment of tracheobronchial stenosis

OBJECTIVE The purpose of this study was to evaluate the potential utility of implantation of a nickel-titanium alloy (nitinol) stent for the treatment of malignant or benign tracheobronchial stenosis. METHODS We evaluated 18 patients (14 men and 4 women) who received 24 nitinol stents, between November 1997 and May 2000. All 18 patients had severe dyspnea caused by tracheobronchial stenosis. The underlying condition was malignant disease in 15 patients, and benign tracheal collapse in the other 3 patients. RESULTS Implantation of the stent was successfully performed in all patients. Seventeen patients experienced immediate clinical improvement in respiratory symptoms. The remaining 1 patient with a bronchial fistule after lobectomy did not benefit, and died of pneumonia at 16 days after the implantation. In 15 patients, the procedure was performed using a flexible bronchoscope under local anesthesia alone, while the remaining 3 patients needed intravenous sedation. There was no complication resulting from the stent implantation. Among the 3 patients with benign tracheal collapse, 2 patients were alive at 746 and at 401 days after the stent implantation, at the time of this report. One patient with cicatricial stenosis after intubation died of heart failure due to previous myocardial infarction. Among the 15 patients with malignant disease, 4 patients have survived for 177 to 305 days to date, while the other 11 patients have died of primary malignancy with a mean survival duration of 60.2 days. CONCLUSION The nitinol stent was effective in treating malignant or benign tracheobronchial stenosis, and had some remarkable advantages compared with other tracheobronchial stents. In stenting, most procedures can be performed using flexible bronchoscope under local anesthesia.

Measurement of antiacetylcholine receptor antibody in patients with thymoma without myasthenia gravis complications

OBJECTIVE Some patients with thymoma reported to show higher antiacetylcholine receptor antibody titers without the preoperative occurrence of myasthenia gravis and some have suffered postoperative complications of myasthenia gravis despite being negative for antiacetylcholine receptor antibody preoperatively. We evaluated changes in antiacetylcholine receptor antibody titers and the occurrence of myasthenia gravis in thymoma patients. METHODS Subjects were 31 of 44 patients with thymoma undergoing thymothymectomy at Tokyo Womens Medical University Hospital between 1987 to 1999 in whom antiacetylcholine receptor antibody titers were measured preoperatively. We studied postoperative changes in antiacetylcholine receptor antibody titers and the presence or absence of myasthenia gravis. RESULTS Eight patients were positive for antiacetylcholine receptor antibody preoperatively, suggesting the presence of subclinical myasthenia gravis. Neither postoperative changes in antiacetylcholine receptor antibody titers nor the occurrence of myasthenia gravis was observed in these 8 patients. Recurrent thymoma and rapid elevation of antiacetylcholine receptor antibody titers were observed postoperatively in 1 patient negative for antiacetylcholine receptor antibody preoperatively, resulting in manifestation of myasthenia gravis symptoms. CONCLUSION We found no correlation between preoperative titers and myasthenia gravis symptoms. Rapid titer elevation indicates the occurrence of myasthenia gravis symptoms or the recurrence of thymoma.

Usefulness of suplatast tosilate for chronic cough following lung cancer surgery

ObjectiveChronic dry cough is reported to occur in about 25% of patients following lung cancer surgery. Experimental data suggest that it may be caused mainly by stimulation of C-fibers, which are widely distributed to the lower trachea and bronchi. We assessed the clinical usefulness of suplatast tosilate (IPD) for chronic dry cough after lung cancer surgery.MethodsThe subjects were patients with stage I lung cancer who had undergone lobectomy combined with mediastinal lymph node dissection. IPD was administered orally at 400 mg daily, and its efficacy was evaluated by patient interview 1, 2, and 3 months after the start of treatment. The subjects were 19 patients, and the duration of cough before entering the study was 393.2 days.ResultsThe response rate was 84.2% (16/19) 1 month after the start of treatment. It seems that IPD inhibits cough resulting from stimulation of the bifurcated trachea with a high content of C-fibers.ConclusionThe present study suggested the efficacy of IPD for controlling chronic dry cough after lung cancer surgery.