Video-Assisted Thoracoscopic Surgery Using Extracorporeal Membrane Oxygenation for Intractable Pneumothorax

Intractable pneumothorax with poor lung function that has received multiple conservative treatments may occur. Case 1 was a 70-year-old woman with aspergilloma who was admitted for pneumothorax. Case 2 was a 68-year-old man with acute exacerbation of interstitial pneumonia who developed pneumothorax. In both cases, multiple conservative therapies were administered, but the leak continued; thus, operations using veno-venous extracorporeal membrane oxygenation (ECMO) were planned. By video-assisted thoracoscopic surgery (VATS), we obtained the optimal surgical field by lung collapse. We removed many blood clots that were used for pleurodesis, ligated the bulla in case 1, and covered the leak point with strengthening agents in case 2. For cases of intractable pneumothorax, lung collapse by ECMO is advantageous because we can check details and leak points even in blood clots or in poor condition of the lung, and we can maneuver the lung in poor condition with a clear surgical field

Tyrosine Phosphorylation Regulates the Expression of Major Histocompatibility Complex Antigens on a Human Lung Cancer Cell Line by Interferon-gamma

Expression of major histocompatibility complex (MHC) antigens on cancer cells is essential for cell-mediated immune function. However, these molecules are reduced on cancer cells enabling them to escape from host immune surveillance. It is well known that interferon-γ (IFN-γ) upregulates the expression of MHC molecules and restores the immunogenicity of cancer cells. Nevertheless, the mechanism by which IFN-γ modulates MHC expression on cancer cells is not clear. Therefore, in this report, we examined the role of tyrosine protein kinases in IFN-γ-induced MHC expression in a human lung adenocarcinoma cell line, HLC-1. We found that a tyrosine protein kinase inhibitor, herbimycin A, inhibited both IFN-γ-inducible MHC class I and class II expression, as assessed by flow cytometry. Additionally, assessment of tyrosine phosphorylation of cellular substrates by confocal laser microscopy using an anti-phosphotyrosine monoclonal antibody (mAb) revealed that IFN-γ induced protein tyrosine phosphorylation within 5 min of treatment. Herbimycin A inhibited this IFN-γ-induced tyrosine phosphorylation. Thus, tyrosine phosphorylation plays an important role in IFN-γ-induced MHC class I and class II expression on HLC-1 cells

Mammary Paget’s Disease with Intraductal Spread: A Patient Report

A 49-year-old woman was diagnosed with mammary Paget’s disease and underwent a modified mastectomy. Paget’s cells were observed not only in the nipple epidermis and adjacent lactiferous ducts, but also at several branches of the lactiferous ducts in the deeper breast. In treating mammary Paget’s disease, the possibility of intraductal spreads should be kept in mind

The Dynamical State of the Serpens South Filamentary Infrared Dark Cloud

We present the results of N_2H^+ (J = 1-0) observations toward Serpens South, the nearest cluster-forming, infrared dark cloud. The physical quantities are derived by fitting the hyperfine structure of N_2H^+. The Herschel and 1.1 mm continuum maps show that a parsec-scale filament fragments into three clumps with radii of 0.1-0.2 pc and masses of 40-230 M_☉. We find that the clumps contain smaller-scale (~0.04 pc) structures, i.e., dense cores. We identify 70 cores by applying CLUMPFIND to the N_2H^+ data cube. In the central cluster-forming clump, the excitation temperature and line-width tend to be large, presumably due to protostellar outflow feedback and stellar radiation. However, for all the clumps, the virial ratios are evaluated to be 0.1-0.3, indicating that the internal motions play only a minor role in the clump support. The clumps exhibit no free fall but exhibit low-velocity infall, and thus the clumps should be supported by additional forces. The most promising force is the globally ordered magnetic field observed toward this region. We propose that the Serpens South filament was close to magnetically critical and ambipolar diffusion triggered the cluster formation. We find that the northern clump, which shows no active star formation, has a mass and radius comparable to the central cluster-forming clump and is therefore a likely candidate of a pre-protocluster clump. The initial condition for cluster formation is likely to be a magnetically supported clump of cold, quiescent gas. This appears to contradict the accretion-driven turbulence scenario, for which the turbulence in the clumps is maintained by the accretion flow

Patient Satisfaction after Endoscopic Thoracic Sympathectomy for Palmar Hyperhidrosis

Endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis was performed using a 3-mm small endoscope at our hospital, and we conducted a questionnaire for the purpose of studying the conditions and satisfaction after surgery. The subjects were comprised of 50 patients, of which 35 patients (75%) answered the survey. The average age of the respondents was 27 years old (range: 12?62 years old) including 13 males and 22 females and the average postoperative observation period was 33 months (1?114 months). The results showed the good effects of surgery in all of the patients for palmar sweating while patient satisfaction was 79.4 points, which concluded that ETS was sufficiently accepted as treatment for palmar hyperhidrosis. However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire

Bilateral Multiple Pulmonary Sclerosing Hemangioma in a Young Male Patient

The patient was a 24-year-old male who visited our University Hospital complaining of chest pain, and chest computed tomography revealed multiple bilateral nodules. The chest pain disappeared almost immediately, but the tumor underwent no changes during the 3 years of follow-up observations. We used a thoracoscope to perform a partial lung resection of a nodule that reached a maximum diameter of 9 mm for the purpose of obtaining a definite diagnosis. From the pathological findings, the patient was diagnosed to have pulmonary sclerosing hemangioma in which circular tumor cells lacking nuclear atypia rose to papillary hyperplasia. The mindbomb homolog-1 positive rate (MIB-1 index) of the tumor cells was less than 1%, and it is believed to have a poor proliferation activity. Pulmonary sclerosing hemangioma is predominantly found in cases of middle-aged female patients and occurs unilaterally. Cases of bilateral multiple forms in young males are extremely rare. Some cases of enlargement, metastasis and relapse have also been reported, so in the future, careful follow-up is required

Thoracoscopic Resection of an Anterior Mediastinal Bronchogenic Cyst

We report a very rare case of anterior mediastinal bronchogenic cyst, successfully resected by thoracoscopic surgery. A 78-year-old female was noted as having an abnormal shadow on her chest X-ray during a routine medical checkup. Chest CT revealed a cystic tumor in the anterior mediastinum. A thymic cyst was suspected after a detailed examination and thoracoscopic surgery was performed. A cystic tumor containing yellowish-white mucus measuring 46 × 33 × 19 mm in size was successfully removed. Calcification was also observed in the cyst wall. Pathologically, the tumor was characterized by a ciliated columnar epithelial lining, and was subsequently diagnosed as a bronchogenic cyst. Although they may be rare, bronchogenic cysts should also be considered in the evaluation of cystic tumors in the anterior mediastinum

Prognostic Factors for Post Recurrence Survival in Resected Pathological Stage I Non-small Cell Lung Cancer

[Background]Recurrence of lung cancer after surgical resection is a major obstacle in the cure and long-term survival of patients and has become the most common cause of death. However, prognostic factors and efficacy of therapy after recurrence remain controversial. We evaluated the prognostic factors of post recurrence survival (PRS) in patients of resected stage I non-small cell lung cancer (NSCLC). [Methods]Of the 551 patients who underwent surgery　for stage I NSCLC between 2005 and 2013, we reviewed 89 (16.2%) patients who had recurrence. We examined PRS using the Kaplan?Meier method and multivariate　Cox regression analyses. [Results]The median follow-up period after recurrence was 21.0 months. The median recurrence free interval (RFI) was 16.8 months. The 1-year PRS and 3-year PRS were 65.6% and 44.7%, respectively. Multivariate analysis revealed that size of primary lesion > 25 mm (P = 0.048), RFI ? 17 months (P = 0.048) and no treatment for recurrence (P < 0.001) were independent poor-prognosis factors of PRS. We further examined PRS in 66 patients who underwent any post recurrence therapy. For the patients who underwent treatment after recurrence, bone metastasis (P = 0.025) and treatment without epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) (P = 0.049) were independent poor prognostic factors. [Conclusion]PRS may be associated with characteristics of a recurrent lesion, including the biology of the recurrent tumor, RFI, recurrent site, the treatment for recurrence, rather than characteristics of primary lesion. Although further validation is needed, this information is important for the design of clinical trials for post-recurrence therapy

Inflammatory Pseudotumor of the Lung Identified by 18F-Fluorodeoxyglucose Positron Emission Tomography: A Patient Report

The patient was a 71-year-old man with an abnormal shadow on chest X-ray. Computed tomography (CT) of the chest showed a tumor of 38 mm in size in the upper lobe of the left lung S3. A CT-guided lung biopsy was performed, but no malignancy was observed. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed a high FDG uptake in the tumor: the maximum and mean values of the standard FDG uptake in the early phase were 7.3 and 5.3, respectively, and those in the latter phase, 8.3 and 5.9, respectively. The hilar and mediastinal lymph nodes also showed positive for high FDG uptakes. We strongly suspected lung cancer, and performed a left upper lobectomy by video-assisted thoracic surgery. The pathological diagnosis was an inflammatory pseudotumor of the lung: it is a rare disease but often requires differentiation from lung cancer. Literature has been few on FDG-PET about inflammatory pseudotumor of the lung. Differentiation of the disease from lung cancer was especially difficult in the present patient, because both lymph nodes and the tumor showed high FDG uptakes