Satoshi Nagasaka

Effect of CD4+ T-lymphocyte count on hospital outcome of elective general thoracic surgery patients with human immunodeficiency virus

PurposeTraditionally, the chief surgical indicator for human immunodeficiency virus (HIV)-infected patients was the CD4-positive T-lymphocyte count; however, there is no current consensus. Reports published after 2006 indicated that HIV-infected patients had a higher incidence of postoperative pneumonia and higher 12-month mortality rates. In addition, CD4 counts had no relation to the in-hospital outcome. Therefore, we retrospectively examined all of the previous patients who underwent operations in our department on the basis of these findings.MethodsRegardless of the initiation of highly active anti-retroviral therapy (HAART), we retrospectively reviewed 10 general thoracic surgeries performed in our department according to the CD4 cell count, HIV-ribonucleic acid (RNA) viral load, time of HAART initiation, operating time, amount of blood, postoperative course, and period of observation.ResultsThere was no incidence of postoperative pneumonia or wound infection. There were also no complications during the perioperative period. One patient died 7 months after surgery.ConclusionOur retrospective study demonstrates that the indicator for elective general thoracic surgery is not the CD4-positive T-lymphocyte count and that the initiation of HAART may reduce the 12-month mortality rates. In HIV-positive patients, regardless of the CD4-positive T-lymphocyte count, surgeons can operate in the same manner as they would with HIV-negative patients.

Video-assisted thoracoscopic surgery can help enable the complete resection of a mediastinal tumor caused by immunoglobulin G4-related disease and avoid the need for postoperative medication: A case report: VATS for IgG4-related mediastinal tumor

Immunoglobulin (Ig) G4‐related disease has various clinical signs and symptoms, and steroidal therapy with corticosteroids has been found to be effective for treatment. Few cases of IgG4‐related disease associated with paravertebral tumor have been reported, and there have been no reports on complete resection of such a tumor. Here, we report a case of IgG4‐related disease associated with a paravertebral tumor that was successfully resected without the need for postoperative medication. An 84‐year‐old woman was admitted to our hospital with a paravertebral tumor. She underwent thoracoscopic surgery, and pathological examination of the tumor specimen revealed that the tumor resulted from IgG4‐related disease. After resection, there was no need for postoperative medication. Our case indicates the rare possibility of a paravertebral tumor associated with IgG4‐related disease and the potential for complete resection as a treatment for such a tumor.

Additional volumetric modulated arc therapy to vertebral metastases abutting the previously irradiated site

Introduction: Lung cancer frequently causes metastases to the spine, especially to the thoracic vertebrae, which sometimes compress the spinal cord and induce irreversible palsy. Many patients suffering from metastatic spinal tumors need to undergo repetitive radiotherapy. In such situations, intensity-modulated radiotherapy including volumetric modulated arc therapy can reduce the dose delivered to the spinal cord at the junction. Case Report: The authors describe a case of thoracic vertebral metastases from lung cancer treated with two courses of radiotherapy. In the second course, volumetric modulated arc therapy was adopted and a columnar-shaped planning target volume with a concave portion was configured. Conclusion: The authors propose an approach aimed at realizing both junctional safety and the conformality of the spinal column, which may be an option for repetitive irradiation to heterochronic spinal metastases.