Pulmonary function after segmentectomy for small peripheral carcinoma of the lung

AbstractObjective: The aim of this study is to compare the pulmonary function after a segmentectomy with that after a lobectomy for small peripheral carcinoma of the lung. Patients And Methods: Between 1993 and 1996, segmentectomy and lobectomy were performed on 48 and 133 good-risk patients, respectively. Lymph node metastases were detected after the operation in 6 and 24 patients of the segmentectomy and lobectomy groups, respectively. For bias reduction in comparison with a nonrandomized control group, we paired 40 segmentectomy patients with 40 lobectomy patients using nearest available matching method on the estimated propensity score. Results: Twelve months after the operation, the segmentectomy and lobectomy groups had forced vital capacities of 2.67 ± 0.73 L (mean ± standard deviation) and 2.57 ± 0.59 L, which were calculated to be 94.9% ± 10.6% and 91.0% ± 13.2% of the preoperative values (P = .14), respectively. The segmentectomy and lobectomy groups had postoperative 1-second forced expiratory volumes of 1.99 ± 0.63 L and 1.95 ± 0.49 L, which were calculated to be 93.3% ± 10.3% and 87.3% ± 14.0% of the preoperative values, respectively (P = .03). The multiple linear regression analysis showed that the alternative of segmentectomy or lobectomy was not a determinant for postoperative forced vital capacity but did affect postoperative 1-second forced expiratory volume. Conclusion: Pulmonary function after a segmentectomy for a good-risk patient is slightly better than that after a lobectomy. However, segmentectomy should be still the surgical procedure for only poor-risk patients because of the difficulty in excluding patients with metastatic lymph nodes from the candidates for the procedure. (J Thorac Cardiovasc Surg 1999;118:536-41

Autoimmune Pancreatitis Exhibiting Multiple Mass Lesions

Our case is a first report of autoimmune pancreatitis with multiple masses within the pancreas which was pathologically diagnosed by endoscopic ultrasound-guided fine needle aspiration and treated by steroid. The masses disappeared by steroid therapy. Our case is informative to know that autoimmune pancreatitis sometimes exhibits multiple masses within the pancreas and to diagnose it without unnecessary surgery

Hemobilia: another complication associated with anti-thrombotic therapy

It is generally accepted that anti-thrombotic therapy increases the risk of gastrointestinal bleeding, and concurrent therapy with a proton-pump inhibitor is the standard treatment for patients receiving aspirin. Therefore, much attention has been paid to the prevention of gastrointestinal bleeding in such patients; however, it should be noted that patients on anti-thrombotic therapy always carry a risk of hemorrhage from any organ, including the gastrointestinal tract. Here, we present a case with formation of a common bile duct stone caused by hemobilia associated with anti-thrombotic therapy. This case suggests that we need to be aware of the possibility of intrabiliary hemorrhage as well as gastrointestinal bleeding in patients receiving anti-thrombotic therapy. Patients with such complications show a variety of symptoms including liver abscess, cholangitis, pancreatitis, and duodenal bleeding