Polymyositis and myocarditis after chemotherapy for advanced thymoma

AbstractPolymyositis and myocarditis very rarely develop during chemotherapy for thymoma. Most reported cases of myocarditis and polymyositis associated with thymoma were found at autopsy of patients who died of acute progression of myocarditis. We describe our experience with a 64-year-old man who had recurrent thymoma accompanied by polymyositis and myocarditis. Lower-extremity myalgia and palpitations developed on day 25 of chemotherapy with weekly paclitaxel. Steroid pulse therapy was effective for the management of polymyositis and myocarditis associated with thymoma. Polymyositis and myocarditis after paclitaxel monotherapy have not been documented previously. Whether paclitaxel induced polymyositis and myocarditis is unclear and these symptoms might have been a paraneoplastic phenomenon associated with thymoma. However, our experience suggested that patients with thymoma who received paclitaxel-based chemotherapy should be carefully observed for polymyositis and myocarditis. If such patients have high serum creatine phosphokinase and troponin levels, steroid pulse therapy should be considered without delay

Using NU-KNIT® for hemostasis around recurrent laryngeal nerve during transthoracic esophagectomy with lymphadenectomy for esophageal cancer

BACKGROUND: We thought that using electrocautery for hemostasis caused recurrent laryngeal nerve palsy. We reflected the prolonged use of electrocautery and employed NU-KNIT® to achieve hemostasis nearby the recurrent laryngeal nerve. We assessed that using NU-KNIT® hemostasis prevented or not postoperative recurrent laryngeal nerve palsy, retrospectively. The present study was evaluated to compare using electrocautery hemostasis with using NU-KNIT® hemostasis during lymphadenectomy along recurrent laryngeal nerve. The variables compared were morbidity rate of recurrent laryngeal nerve palsy, operation time, and blood loss. RESULTS: We use NU-KNIT® to achieve hemostasis without strong compression. This group is named group N. On the other hand, we use electrocautery to achieve hemostasis. This group is named group E. Complication rate of recurrent laryngeal nerve palsy was higher in group E (55.6%) than group N (5.3%) (p = 0.007). CONCLUSIONS: Even hemostasis using NU-KNIT® was slightly more time-consuming than using electrocautery, we concluded that it would be useful to prevent recurrent laryngeal nerve palsy

EGFR mutation and ALK fusion-positive non-small cell lung cancer: a multicenter prospective cohort study in Nagano Prefecture, Japan

Introduction. We prospectively examined current clinical practices in patients with inoperable epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) fusion-positive (EGFR+ and ALK+, respectively) non-small cell lung cancer (NSCLC) in Nagano Prefecture, Japan.  Material and methods. The study population consisted of newly diagnosed patients with inoperable EGFR+ and ALK+ NSCLC in 14 hospitals in Nagano between May 2016 and March 2019. Both initial and subsequent treatment decisions were made at the discretion of the attending physician.  Results. A total of 281 patients with EGFR+ NSCLC (mean age, 74 years, 59.1% female) and 26 patients with ALK+ NSCLC (mean age, 66 years, 53.8% female) were included in the study. The study population consisted of 148/107/29/20/3 cases with performance status 0/1/2/3/4 and 6/2/31/194/75 cases with clinical stage I/II/III/IV/recurrence, respectively. First-line therapy with tyrosine kinase inhibitors was performed in 259 (92.2%) and 22 (84.6%) patients with EGFR+ and ALK+ NSCLC, respectively. The median overall survival rate was 41.2 months (95% CI 36.8–45.6 months) with EGFR+. It was not reached with ALK+ .  Conclusions. This observational analysis represents a valuable resource for evaluating the outcomes of treatment in patients with NSCLC