A pitfall of thoracoscopic thymectomy: a case with intraoperative and postoperative complications

Abstract We have reported the usefulness of the subxiphoid approach in thymectomy. However, such a new operation method may have unknown complications that rarely occur. Surgeons cannot completely avoid intraoperative and postoperative complications. We report a case of intraoperative injury of the orifice of the left internal thoracic vein flowing to the left brachiocephalic vein and postoperative pericarditis following video-assisted thoracic surgery (VATS) thymectomy. The innominate vein has been considered to be the vessel that is most frequently injured especially at the orifice of the thymic veins. We also suggest that the orifice of the left internal thoracic vein is the second dangerous location that requires special care. In addition, postoperative pericarditis occurred in this patient. Pericardial drainage was necessary. No additional complications have been found in the 9 months since the operation. Though VATS thymectomy using the subxiphoid approach is a safe and less-invasive operation, intraoperative and postoperative complications were possible to be occurred

Thymic Carcinoma: 30 Cases at a Single Institution

IntroductionThymic carcinoma is a rare and invasive mediastinal neoplasm that often metastasizes. It constitutes a heterogeneous group of tumors that displays different biologic behavior and prognosis. The clinical prognostic factors and treatment of thymic carcinoma are not yet standardized.MethodsThirty patients with thymic carcinoma have been treated at Nagoya City University Hospital since 1983. The clinical and pathologic data of these patients were retrospectively reviewed. Thirteen cases were considered to be unresectable or inoperable and received chemotherapy or chemoradiotherapy. Seventeen cases underwent resection; total in 7 cases and subtotal in 10 cases. Postoperative irradiation was added as adjuvant therapy in the tolerable cases. The most recent five cases received induction chemotherapy.ResultsIn 17 of the 30 cases, the patients died. The survival periods in the death cases were from 2.4 to 78.1 months (mean, 32.4 months; median, 21.0 months). The observation periods in the 13 live cases were 6.3 to 232 months (average follow-up, 64.6 months). The 5-year survival rate was 47.5%, and median survival time (MST) was 49.0 months. Cases that underwent total resection showed significantly better prognosis than cases with subtotal resection (p = 0.011) and inoperable cases (p = 0.002). The cases that underwent subtotal resection showed significantly better prognosis than the inoperable cases (p = 0.050). The cases with hematogenous metastasis demonstrated significantly poorer prognosis (p = 0.021), but lymphogenous metastasis was not a significant predictor of poor prognosis. Only resectability was a significant prognostic factor in multivariate Cox regression analysis, and the hazard ratio was 5.123.ConclusionsResectability was the only prognostic factor in thymic carcinoma. We suggest the importance of preoperative precise evaluation to exclude unresectable Masaoka stage IVb disease and expect preoperative chemotherapy or chemoradiotherapy to improve the respectability

Increased Synthesis of Anti-Tuberculous Glycolipid Immunoglobulin G (IgG) and IgA with Cavity Formation in Patients with Pulmonary Tuberculosis▿

Tuberculous glycolipid (TBGL) antigen is a cell wall component of Mycobacterium tuberculosis and has been used for the serodiagnosis of tuberculosis. We investigated correlations between the levels of anti-TBGL antibodies and a variety of laboratory markers that are potentially influenced by tuberculous infection. Comparisons between patients with cavitary lesions and those without cavitary lesions were also made in order to determine the mechanism underlying the immune response to TBGL. Blood samples were obtained from 91 patients with both clinically and microbiologically confirmed active pulmonary tuberculosis (60 male and 31 female; mean age, 59 ± 22 years old). Fifty-nine patients had cavitary lesions on chest X-rays. Positive correlations were found between anti-TBGL immunoglobulin G (IgG) and C-reactive protein (CRP) (r = 0.361; P < 0.001), between anti-TBGL IgA and soluble CD40 ligand (sCD40L) (r = 0.404; P < 0.005), between anti-TBGL IgG and anti-TBGL IgA (r = 0.551; P < 0.0000005), and between anti-TBGL IgM and serum IgM (r = 0.603; P < 0.00000005). The patients with cavitary lesions showed significantly higher levels of anti-TBGL IgG (P < 0.005), anti-TBGL IgA (P < 0.05), white blood cells (P < 0.01), neutrophils (P < 0.005), basophils (P < 0.0005), natural killer cells (P < 0.05), CRP (P < 0.0005), KL-6 (sialylated carbohydrate antigen KL-6) (P < 0.0005), IgA (P < 0.05), and sCD40L (P < 0.01). The observed positive correlations between the anti-TBGL antibody levels and inflammatory markers indicate the involvement of inflammatory cytokines and NKT cells in the immunopathogenesis of pulmonary tuberculosis