A 65-year-old female was admitted to our hospital because of bilateral pleural and pericardial effusion. She underwent pacemaker implantation elsewhere for complete A-V block at age 60, ...re-implantation at age 61 due to pacemaker pocket infection, and was treated with antibiotics for idiopathic mediastinitis at age 65. She was diagnosed with bilateral chylothoraces and chylopericardium by thoracocentesis and pericardiocentesis. Bilateral pleural drains and a pericardial drain were inserted. Neither lymphangiography nor radioisotope lymphography revealed the site of chyle leakage. Her pleural and pericardial effusion did not decrease in spite of a low-fat diet. So, she underwent thoracoscopic ligation of the thoracic duct and pericardiotomy through the right thorax. After the surgery, pericardial effusion disappeared but pleural effusion persisted. She developed respiratory failure because of pleural effusion, and had to undergo thoracocentesis repeatedly. As her malnutrition progressed gradually due to the loss of chyle, bilateral pleuroperitoneal shunt (using Denver Shunt®) was performed 84 days after the first surgery. Bilateral pleural effusion was well controled, her nutrition status recovered, and no further therapeutic intervention for chylothorax was required. She underwent removal of the initially inplanted pacemaker lead due to a subsequent septic episode 17 months after the shunt operation, and no further pumping of the shunt tube was needed thereafter. This is a rare case in which the pacemaker lead was a possible cause of chylothorax. We think that pleuroperitoneal shunt can be an effective therapy for persistent chylothorax.
Pulmonary metastasectomy (PM) for breast cancer-derived pulmonary metastasis is controversial. This study aimed to assess the prognostic factors and implication of PM for metastatic breast cancer ...using a multi-institutional database.
Clinical data of 253 females with pulmonary metastasis of breast cancer who underwent PM between 1982 and 2017 were analyzed retrospectively.
The median patient age was 56 years. The median follow-up period was 5.4 years, and the median disease-free interval (DFI) was 4.8 years. The 5- and 10-year survival rates after PM were 64.9% and 50.4%, respectively, and the median overall survival was 10.1 years. Univariate analysis revealed that the period of PM before 2000, a DFI <36 months, lobectomy/pneumonectomy, large tumor size, and lymph node metastasis were predictive of a worse overall survival. In the multivariate analysis, a DFI <36 months, large tumor size, and lymph node metastasis remained significantly related to overall survival. The 5- and 10-year cancer-specific survival rates after PM were 66.9% and 54.7%, respectively, and the median cancer-specific survival was 13.1 years. Univariate analyses revealed that the period of PM before 2000, DFI <36 months, lobectomy/pneumonectomy, large tumor size, lymph node metastasis, and incomplete resection were predictive of a worse cancer-specific survival. Multivariate analysis confirmed that a DFI <36 months, large tumor size and incomplete resection were significantly related to cancer-specific survival.
As PM has limited efficacy in breast cancer, it should be considered an optional treatment for pulmonary metastasis of breast cancer.
Pulmonary artery (PA) sling is a congenital disease in which the left PA abnormally arises from the right PA and is usually diagnosed during the infantile period. We present an adult case of PA sling ...accompanied by tracheobronchomalacia found in a 49-year-old woman with a history of recurrent pneumonia. Computed tomography of the chest showed that the left lung was nourished by two aberrant PAs. Bronchoscopy demonstrated achondroplasia of the trachea and the right bronchus, which we speculate to have resulted in their stenosis. The recurrent pneumonia was attributable to these tracheobronchial structural abnormalities; we therefore stress the importance of focusing on the anatomic abnormalities in such cases.
There is little evidence of the outcome of pulmonary metastasectomy for uterine tumors when comparing different histologies. This study aimed to delineate the primary histology that leads to more ...favorable outcomes after pulmonary metastasectomy.
The database of the Metastatic Lung Tumor Study Group of Japan for 1984 to 2016 was used to analyze the outcomes of patients with gynecologic malignancies who underwent pulmonary metastasectomy. Prognostic factors and long-term outcomes were compared according to the histology of the primary uterine tumors, specifically adenocarcinoma, squamous cell carcinoma, and sarcoma. The adjusted hazard risks according to disease-free intervals (DFIs) and the number and maximum size of resected tumors were also analyzed to delineate the pattern of risk trends.
A total of 319 patients were included in the analysis (122 with adenocarcinomas, 113 with squamous cell carcinomas, 46 with sarcomas, and 38 with other types). The 5-year survival rate was 66.5% for the entire cohort, 71.6% for the patients with adenocarcinoma, 61.3% for those with squamous cell carcinoma, and 55.4% for those with sarcoma. Multivariate analyses identified the positive prognostic factors as DFI ≥12 months in adenocarcinoma and sarcoma and the primary site (corpus) of uterine tumors in adenocarcinoma. The nonlinear adjusted hazard risks indicated that a shorter DFI was associated with an elevated risk of death in patients with adenocarcinoma and sarcoma.
The survival outcome after pulmonary metastasectomy varies according to primary tumor histology, and the prognostic factors differ among histologic subtypes. Surgical indications should be determined based on the prognostic factors for each histology.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A 73-year-old man underwent right lower lobectomy for lung adenocarcinoma. On day 9 after the operation, bronchofiberscopic findings showed ulcerative changes in the bronchial stump. On day 16, ...ulcerative changes and partial necrosis of the bronchial stump led to bronchopleural fistula formation. Surgical treatment was considered, but the patient was asymptomatic and the empyema cavity was very narrow; thus, we chose conservative therapy. Although aspiration pneumonia developed, the fistula healed spontaneously on day 43. Conservative therapy was successful, because the empyema cavity was very narrow, and the control of infection and the patient's nutritional condition were relatively favorable.
Highlights • We assessed gene expression levels of 5-FU related enzymes in stage I/II NSCLC. • Tumors from 236 patients with UFT administration after surgery were examined. • Thymidylate synthase ...gene expression was an independent predictive factor for DFS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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