Takehiro Tsuchiya

Resection of solitary pulmonary lesion is beneficial to patients with a history of malignancy.

BACKGROUND Solitary pulmonary lesion poses a diagnostic challenge, especially in patients with a history of malignancy. The purpose of this study was to evaluate the characteristics of solitary pulmonary lesions and the outcome of surgical resection. METHODS We retrospectively analyzed 243 patients with a history of cancer who underwent surgery for new-found solitary pulmonary lesion between January 1998 and December 2007. RESULTS The diagnosis was primary lung cancer in 92 patients, metastasis in 133, and benign lesions in 18. The 5-year survival rate was 67.9% in all patients, 74.6% in those with primary lung cancer, 62.8% in those with metastasis, and 79.9% in those with benign lesions (p = 0.56). In metastasis patients, history of extrapulmonary recurrence and larger diameter lesion were risk factors for recurrence by multivariate analysis. History of cancers other than colorectal and bone and soft tissue sarcoma and shorter disease-free interval were indicators of poor prognosis. Pathologic stage was the only indicator of prognosis for primary lung cancer, and none of the factors concerning antecedent cancer influenced prognosis. CONCLUSIONS Surgical resection of solitary pulmonary lesion is essential in patients with a history of cancer because substantial numbers of benign lesions are included. In the case of malignancy, metastasectomy had a life-prolonging effect for selected patients, and prognosis of primary lung cancer was no worse than for the general population if treated appropriately. It is important not to hesitate to take a surgical approach for a diagnosis and to treat with standard therapy for primary lung cancer.

Significance of the Glasgow Prognostic Score as a prognostic indicator for lung cancer surgery.

OBJECTIVES The Glasgow Prognostic Score (GPS), which is calculated with C-reactive protein (CRP) and albumin (Alb) values, is a prognostic indicator for various types of cancers. However, its role in lung cancer still remains unclear, and its optimal cut-off values are controversial. Here, we evaluated the significance of the GPS and adjusted GPS (a-GPS) using our institutions cut-off values in patients undergoing resection for primary lung cancer. METHODS We analysed 1043 lung cancer patients who underwent resection between 1998 and 2012. The overall survival (OS) probabilities of the GPS subgroups were estimated using the Kaplan-Meier method and were compared using the log-rank test. The prognostic significance of the GPS and the a-GPS was assessed by the Cox proportional hazards model with clinicopathological variables and inflammation markers, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). The GPS was calculated based on cut-off values of 1.0 mg/dl for CRP and 3.5 g/dl for Alb, as previously reported. The a-GPS was calculated based on cut-off values 0.3 mg/dl for CRP and 3.9 g/dl for Alb, which are the standard thresholds used by our institution. RESULTS The GPS and the a-GPS were correlated with preoperative factors, such as age, sex, smoking status, the NLR and the PLR, and oncological factors, including the pathological stage, histological type and level of lymphovascular invasion. The 5-year OS rates were 82, 55 and 55% with GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.66), respectively, and 88, 67 and 59% with a-GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.04), respectively. Multivariable analysis revealed that the GPS [1 vs 0, hazard ratio (HR): 1.63, 2 vs 0, HR: 1.44] and the a-GPS (1 vs 0, HR: 2.00, 2 vs 0, HR: 2.10) were independent prognostic factors. The a-GPS classification showed a clearer prognostic distribution than the GPS classification. CONCLUSIONS The GPS is a useful prognostic indicator of the OS in lung cancer surgery. The optimal cut-off values for GPS estimation may need to be re-evaluated.

Scandium perfluoroalkanesulfonate-catalyzed Diels–Alder reactions in an organic solvent

Abstract Scandium perfluoroalkanesulfonate-catalyzed Diels–Alder reactions proceeded smoothly in dry dichloromethane in the presence of molecular sieves (MS) 5 A. It was found that water interfered with the reactions, contrary to most rare earth-catalyzed reactions that proceed smoothly in aqueous media. Among scandium perfluoroalkanesulfonates tested, scandium triflate (Sc(OTf) 3 ), scandium pentafluoroethanesulfonate (Sc(OSO 2 C 2 F 5 ) 3 ), and scandium nonafluorobutanesulfonate (Sc(OSO 2 C 4 F 9 ) 3 ) gave the highest yields and selectivities.

Loss of YAP1 defines neuroendocrine differentiation of lung tumors

YAP1, the main Hippo pathway effector, is a potent oncogene and is overexpressed in non‐small‐cell lung cancer (NSCLC); however, the YAP1 expression pattern in small‐cell lung cancer (SCLC) has not yet been elucidated in detail. We report that the loss of YAP1 is a special feature of high‐grade neuroendocrine lung tumors. A hierarchical cluster analysis of 15 high‐grade neuroendocrine tumor cell lines containing 14 SCLC cell lines that depended on the genes of Hippo pathway molecules and neuroendocrine markers clearly classified these lines into two groups: the YAP1‐negative and neuroendocrine marker‐positive group (n = 11), and the YAP1‐positive and neuroendocrine marker‐negative group (n = 4). Among the 41 NSCLC cell lines examined, the loss of YAP1 was only observed in one cell line showing the strong expression of neuroendocrine markers. Immunostaining for YAP1, using the sections of 189 NSCLC, 41 SCLC, and 30 large cell neuroendocrine carcinoma (LCNEC) cases, revealed that the loss of YAP1 was common in SCLC (40/41, 98%) and LCNEC (18/30, 60%), but was rare in NSCLC (6/189, 3%). Among the SCLC and LCNEC cases tested, the loss of YAP1 correlated with the expression of neuroendocrine markers, and a survival analysis revealed that YAP1‐negative cases were more chemosensitive than YAP1‐positive cases. Chemosensitivity test for cisplatin using YAP1‐positive/YAP1‐negative SCLC cell lines also showed compatible results. YAP1‐sh‐mediated knockdown induced the neuroendocrine marker RAB3a, which suggested the possible involvement of YAP1 in the regulation of neuroendocrine differentiation. Thus, we showed that the loss of YAP1 has potential as a clinical marker for predicting neuroendocrine features and chemosensitivity.

Outpatient Treatment of Pneumothorax with a Thoracic Vent: Economic Benefit

Background: Since rising medical costs currently represent a growing problem worldwide, finding cost-effective treatment options is important. In our hospital, outpatient treatment of pneumothorax using a thoracic vent began in December 2012. Objectives: We aimed to test our hypothesis that outpatient treatment of pneumothorax with a thoracic vent can reduce medical expenses. Methods: Patients were classified into four groups based on treatment: thoracic vent with or without surgery or conventional intercostal chest tube drainage with or without surgery. We compared mean medical expenses, duration of hospitalization and number of physician visits among these four groups. Results: During a 2-year period, 65 patients were treated with a thoracic vent (36 patients) or conventional intercostal chest tube drainage (29 patients). Patients treated with a thoracic vent who underwent surgery had a shorter mean duration of hospitalization (5.0 ± 1.3 vs. 10.3 ± 3.4 days; p < 0.0001) and lower overall cost, at JPY 971,830.00 ± 81,291.80 (USD 10,400.40 ± 1,464.90) versus JPY 1,179,791.10 ± 198,383.10 (USD 13,888.90 ± 1,965.30; p < 0.0001) compared with conventional intercostal chest tube drainage. Nonsurgical patients treated with a thoracic vent had lower overall costs, at JPY 79,960.00 ± 25,643.60 (USD 890.10 ± 352.30) versus JPY 268,588.80 ± 94,636.50 (USD 2,932.80 ± 903.50; p < 0.0001) compared with conventional intercostal chest tube drainage. No serious complications were observed. Conclusions: Outpatient thoracic vent treatment can significantly reduce medical expenses and thereby have a major economic impact.

Outpatient Drainage Therapy with a Thoracic Vent for Traumatic Pneumothorax due to Bull Attack

Outpatient drainage therapy is generally indicated for spontaneous pneumothoraces. A 63-year-old man, who had been attacked by a bull sustaining injuries on the right side of his chest, was referred to the emergency room with dyspnea. His chest X-ray showed a small pneumothorax. The next day, a chest X-ray demonstrated that his pneumothorax had worsened, although no hemothorax was identified. Outpatient drainage therapy with a thoracic vent was initiated. The air leak stopped on the third day and the thoracic vent was removed on the sixth day. Thoracic vents can be a useful modality for treating traumatic pneumothorax without hemothorax.

Thoracoscopic Surgery for Multiple Peripheral Pulmonary Arteriovenous Fistulas

A 37-year-old woman with dyspnea was referred to our department with the diagnosis of multiple bilateral pulmonary arteriovenous fistulas. Computed tomography of the chest showed nine fistulas in the right lung and four in the left lung. Because the fistulas were small and located peripherally, we chose thoracoscopic surgery instead of transcatheter pulmonary artery embolization. Intraoperatively, we identified four additional fistulas in the left lung. We resected 15 abnormal vessels and ligated two vessels during thoracoscopic surgery. Postoperatively, her dyspnea decreased and arterial blood oxygenation improved. Thoracoscopic surgery is a good treatment option for multiple small peripheral pulmonary arteriovenous fistulas.

Virtual Bronchoscopy Using OsiriX.

Background:Although the utility of virtual bronchoscopy has been reported, the software for virtual bronchoscopy has not been popular because of the high cost. OsiriX is a reasonably priced software that is available to reconstruct virtual endoscopic images. Herein, we present the ability of OsiriX to enable virtual bronchoscopy. Methods:Computed tomography of the chest was performed using a 16-row multidetector. Data in 2 mm slices from one lung were obtained from 10 patients with a lung nodule. Virtual bronchoscopic images were established by OsiriX version 5.5 (32-bit). To examine the ability to visualize small bronchi, we tried to visualize the distal bronchus if possible. We selected B1a and B10c for the right lung and B1+2a and B10c for the left lung. In addition, to predict whether a pathologic diagnosis can successfully be made by transbronchial lung biopsy, we reconstructed virtual bronchoscopic images toward the lung nodule. Results:Bronchoscopic images were successfully reconstructed for all patients. The third to the seventh bronchi were visualized except in one patient whose right B10 was occluded by a tumor. In all patients, the virtual bronchoscopic path reached the lung nodule, and 5 lung nodules were successfully diagnosed by transbronchial biopsy. Conclusions:OsiriX is practicable for virtual bronchoscopy at a low cost.

Outpatient drainage for patients with spontaneous pneumothorax over 50 years of age

Introduction: The British Thoracic Society has reported a lower success rate for aspiration of spontaneous pneumothorax in patients over 50 years of age. Outpatient drainage therapy is used to manage spontaneous pneumothorax at some institutions. We examined the effect of age on outpatient drainage therapy outcomes. Materials and Methods: We reviewed the records of 68 patients who underwent outpatient drainage therapy with a thoracic vent between December 2012 and April 2015, which included 11 patients over 50 years of age. Indications for outpatient drainage therapy included pneumothorax with no circulatory or respiratory failure and no pleural effusion. Results: Of the 11 patients over 50 years of age, 5 had chronic obstructive pulmonary disease (COPD), one had interstitial pneumonia, one had a history of pulmonary tuberculosis, and one has lung tumors (LTs). Among the 57 younger patients, 2 patients had COPD, and one had LTs. Unexpected hospital admission occurred in 2 patients over 50 years of age and one patient aged 50 years or less (P = 0.0658, Fishers exact test). Six of the 11 patients over 50 years of age underwent surgery for prolonged air leakage, compared to 8 of the 57 younger patients (P = 0.00695, Fishers exact test). Conclusions: Outpatient drainage therapy is useful for patients with spontaneous pneumothorax over 50 years of age, because outpatient drainage therapy alone was successful in 4 of 11 patients and admission for drainage was avoided in 9 of 11 patients. However, prolonged air leakage occurs more frequently in this age group.

Right Pleural Empyema Secondary to Liver Abscess Due to Klebsiella pneumoniae

A 64-year-old man with fever and dyspnea was referred to our hospital. He was diagnosed with right pleural empyema secondary to a liver abscess due to Klebsiella pneumoniae. He was successfully treated with decortication via a thoracotomy and percutaneous drainage of the liver abscess. Although it is very rare, we should keep in mind that pleural empyema can be caused by a liver abscess due to K pneumoniae.