Takamasa Ohnuki

Proposal of a new prognostic staging system for pulmonary metastases from colorectal cancer

PurposeThe aim of this retrospective study was to establish a new prognostic staging system for pulmonary metastases from colorectal carcinoma (CRC).MethodsThe baseline characteristics and outcomes on 352 CRC patients who underwent complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group (group A). The clinical and pathological factors were entered into a multivariate analysis to identify independent variables that were helpful for accurately predicting the long-term prognosis after pulmonary resection. Using the selected variables in group A, we developed a new prognostic staging system (PSS). The new PSS was examined in a validation study in a series of 841 patients from 110 institutions of the JSCCR by the 78th society of the JSCCR (group B).ResultsWe evaluated four variables selected in the multivariate analysis: the number of pulmonary metastases, the distribution, the disease-free interval and the lymph node metastases of primary cancer in group A. Using these four variables, we developed a new PSS. This PSS was found to significantly predict the prognosis in group B.ConclusionsOur new PSS was useful for the selection of patients suitable for pulmonary resection.

Does Potassium Ion Concentration Affect Lung Preservation

+, 0 mmol/l K+; (2) 150 mmol/l Na+, 5 mmol/l K+; (3) 20 mmol/l Na+, 135 mmol/l K+; and (4) 0 mmol/l Na+, 155 mmol/l K+. All four solutions possessed the same osmolarity, the same pH in the same temperature, and the same buffer action. Lungs were preserved at 7°C in these solutions for 24 h and evaluated in a rat lung perfusion system with perfluorochemical emulsion. Pressure-limited perfusions with pressure-limited ventilation were carried out for 20 min before and after preservation. Thereafter, the recovery ratios of pulmonary arterial flow (Q˙), tidal volume (VT), oxygen tension of the pulmonary venous effluent (PPVO2), and wet-to-dry ratios were compared. The recovery ratios of Q˙ were better in low, but not zero, potassium solutions, whereas wet-to-dry ratios were kept lower in high potassium solutions. No difference in pulmonary compliance or gas exchange was observed against a great change in potassium ion concentration. Therefore, the potassium ion concentration did not play a major role in lung preservation.

A case of traumatic diaphragmatic hernia manifesting itself half a year after injury

外傷性横隔膜ヘルニアは早期に診断・治療されることが多いが，我々は受傷後半年を経て診断された症例を経験した．症例は38歳男性．外傷による脳挫傷・下顎骨折・肋骨骨折の後，半年を経過して横隔膜ヘルニアを診断された．胸腔内の癒着が予想され胸腔鏡にて経胸的アプローチを採用したが，脱出臓器の腹腔内への整復が困難であったため，後側方開胸に変更した．癒着の有無や臓器の胸腔内脱出の程度の確認に，胸腔鏡が有用であり，癒着例や腹腔内還納の困難な症例に対し開胸に移行するのが理に適うと考えた．