階段昇降試験中に認められる酸素飽和度低下 : 肺切除を予定している患者の術後合併症の予測指標

Objective: It is widely accepted that exercise tolerance tests are applicable in perioperative risk assessment for patients who undergo pulmonary resection; however, the relevance of desaturation during the test is unclear. The purpose of this study was to investigate whether the occurrence of desaturation during a stair-climbing test can be a predictor of postoperative complications among patients who will undergo pulmonary resection and are considered "normal risk" according to published guidelines. Methods: Desaturation was defined as a depression of more than 4% points on a pulse oximeter during stair climbing. Among 186 consecutive patients who underwent pulmonary resection, 162 patients who could climb to the 6th floor were selected for the study (excluding 21 patients who could not stair-climb and 3 patients who could not climb from the first floor to the sixth floor). The relationship of desaturation with postoperative complication was investigated using parameters of cardio-pulmonary status associated with additional foci of oxygen supply duration, intensive care unit stay duration, and hospital stay duration. Results: The occurrence ratio of postoperative complications > grade 3 (Clavien-Dindo classification) was 0.75% (1/133) among patients without desaturation and 17.2% (5/29) in patients with desaturation (difference: p = 0.0002). In addition, DS was an indicator of prolonged oxygen supply duration, intensive care unit stay duration, and hospital stay duration. Conclusion: The occurrence of desaturation during a stair-climbing test for patients who will undergo pulmonary resection can be a predictor of postoperative complications among patients who are classified as having normal risk.博士（医学）・乙第1457号・令和2年6月30日© The Japanese Association for Thoracic Surgery 2019© 2019 Springer Nature Switzerland AG. Part of Springer Nature.This is a post-peer-review, pre-copyedit version of an article published in General thoracic and cardiovascular surgery. The final authenticated version is available online at: http://doi.org/10.1007/s11748-019-01153-z.本文の登録不可。本文は以下のURLを参照 "https://doi.org/10.1007/s11748-019-01153-z"（※全文閲覧は学内限定

A New Minimally Invasive Technique of Combined Chest Wall Resection for Lung Cancer : Advanced Data of Implication of Advanced Bipolar Device in Video-Assisted Chest Wall Resection for Lung Cancer.

We describe a novel method for resecting lung cancer that has invaded the chest wall using an advanced bipolar device during video-assisted thoracoscopic surgery. The method is convenient for both tumor and chest wall resection because it is easy to handle and less invasive than the currently used technique

Effectiveness of Cross‐Linked Gelatin Glue in Canine Lung Surgery Models.

Background. Air leakage is a common postoperative complication in pulmonary surgery, and surgical sealants have been developed to prevent or reduce the incidence of air leaks. In this study, we evaluated the efficacy of cross-linked gelatin glue (gelatin plus glutaraldehyde) in canine lung surgery models. Methods. Pulmonary fistulas and injuries were created in dogs and sealed with gelatin glue, fibrin glue, or fibrin glue with a polyglycolic acid (PGA) sheet. Seal-breaking pressures were measured in the fistula model, and pleural adhesions were assessed 28 days postoperatively in the lung injury model. Results. The seal-breaking pressures for canine cadaver and living lung surgeries (; the maximum pressures were 80 and 40 cm H₂O) were respectively: gelatin glue, 77 ± 6 and 32.3 ± 8.9cm H₂O; fibrin glue using spray, 39.2 ± 9.3 and 32 ± 6cm H₂O; fibrin glue using the rub-and-soak method, 35 ± 13.4 and 40 ± 0 cm H₂O; and fibrin glue with a PGA sheet, 55.5 ± 18.2 and 39 ± 2cm H₂O. In the lung injury model, there were no chest wall adhesions in the gelatin and fibrin glue alone groups, while strong adhesions were observed when treated with fibrin glue with a PGA sheet. Conclusions. Gelatin glue's sealing effect was superior to that of fibrin glue while preventing postoperative pleural adhesions. These findings suggest that gelatin glue may be effective as a surgical sealant or anti-adhesion materialin lung surgery

Factors influencing the opinion of individuals in determining tumour spread after biopsy

<p>Abstract</p> <p>Background</p> <p>People often have concerns regarding tumour spread after biopsy which leads to a delay in seeking expert medical advice. The data regarding this perception is scanty. Therefore, we conducted this cross sectional study to explore the beliefs and perceptions of individuals regarding tumour spread after biopsy and the basis of those beliefs.</p> <p>Methods</p> <p>The survey was conducted in outpatient areas of two different tertiary care hospitals of Karachi namely Aga Khan University Hospital Karachi (AKUH) and Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN). We interviewed 600 individuals and documented their responses on a questionnaire. There were 400 responders from Aga Khan's Consulting Clinic and 100 each from Aga Khan's Oncology Clinic and KIRAN.</p> <p>Results</p> <p>Only 50% of the respondents chose biopsy as the best test for diagnosis of cancer. The level of education was statistically significant in making this choice of answer (<it>p </it>= 0.02) only in univariate analysis. Those individuals who were involved in the work up of cancer patients irrespective of their educational status gave more intelligent answers (<it>p </it>= 0.003). The tumour disturbance after biopsy was regarded as a major factor among 127 respondents (53%) who believed that biopsy could lead to spread of tumour.</p> <p>Conclusions</p> <p>Our study revealed that awareness regarding cancer diagnosis and biopsy is lacking among general public and it does not co-relate well with the level of formal education. These misconception and taboos need to be addressed in public seminars and in the media in order to increase the awareness which could facilitate prompt diagnosis.</p

Predictors of survival for younger patients less than 50 years of age with non-small cell lung cancer (NSCLC): A California Cancer Registry analysis

BackgroundNon-small cell lung cancer (NSCLC) is uncommonly diagnosed in patients younger than 50 years of age. We analyzed the California Cancer Registry (CCR) to describe epidemiologic characteristics and outcomes in this patient subset and to identify factors prognostic for cause-specific survival (CSS).MethodsPatients diagnosed with NSCLC between 1/1/98 through 12/31/09 and reported to the (CCR) as of October 2011 were included. The primary outcome measure was CSS. Cox regression models were used to evaluate predictors of CSS in young patients with NSCLC, adjusted for potential confounders. Interaction analysis was performed between age groups (&lt;50 vs. ≥50) and specific demographic and tumor covariates.ResultsWe identified 132,671 lung cancer cases, of which 114,451 (86.3%) had NSCLC. Of these, 6389 (5.6%) were&lt;50 years of age (median, 46 years). The most common histology was adenocarcinoma (3697, 57.9%). Most patients had stage III (1522, 23.8%) or IV (3655, 57.2%) disease. Fewer young patients were diagnosed in recent years (n, % of total NSCLC population of that era): 1998-2001 (2355, 6.0), 2002-2005 (2182, 5.7), and 2006-2009 (1852, 5.0), P&lt;0.001. Multivariate analysis showed that age &lt;50 years was an independent predictor of improved CSS (HR 0.827, P&lt;0.001). Significant predictors of better CSS in patients &lt;50 years included female sex, Asian or Hispanic ethnicity, lower stage, later year of diagnosis, and higher socioeconomic status, among others. Adenocarcinoma histology was not associated with improved CSS in this patient subset (HR 0.987, P=0.78). Interaction analysis revealed that Hispanic race and bronchioloalveolar histology had differential CSS outcomes dependent on age group.ConclusionsThis large registry study found that age &lt;50 years is an independent predictor of improved CSS. Variables prognostic for CSS differed somewhat from those in older patients

CXCR4 expression on circulating pan-cytokeratin positive cells is associated with survival in patients with advanced non-small cell lung cancer

<p>Abstract</p> <p>Background</p> <p>The CXC chemokine, CXCL12, and its receptor, CXCR4 promote metastases of a variety of solid tumors, including non-small cell lung cancer (NSCLC). The expression of CXCR4 on tumor cells may represent a critical biomarker for their propensity to metastasize. This study was performed to evaluate the hypothesis that co-expression of pan-cytokeratin and CXCR4 may be a prognostic marker for patients with advanced NSCLC.</p> <p>Methods</p> <p>We evaluated CXCR4 levels on circulating pan-cytokeratin positive cells from patients with NSCLC. NSCLC tumor and metastases were also assessed for the presence of CXCR4.</p> <p>Results</p> <p>Pan-cytokeratin positive cells were increased in the circulation of patients with NSCLC, as compared to normal control subjects. Patients with pan-cytokeratin +/CXCR4+ = 2,500 cells/ml had a significant improvement in median survival when compared with patients with pan-cytokeratin +/CXCR4+ >2,500 cells/ml (not achieved versus 14 weeks). CXCR4 expression was found on NSCLC tumors and at sites of tumor metastasis.</p> <p>Conclusion</p> <p>This study suggests that CXCR4 may be a prognostic marker in NSCLC, and provides hypothesis-generating results, which may be important in determining metastatic potential. In future studies, we will prospectively evaluate the prognostic significance of pan-cytokeratin/CXCR4+ cells, and determine the mechanisms involved in the regulation of CXCR4 expression on tumor cells in a larger patient population.</p