Background Preoperative localization of pulmonary nodules is sometimes necessary when they are too small or distant from the surface of the visceral pleura to be detected during video-assisted ...thoracoscopic surgery. This study aims to present the criteria for localization and to evaluate the accuracy of the criteria. Methods From April 2001 to March 2008, 178 patients with 224 nodules who underwent wedge resection of pulmonary metastatic nodules by video-assisted thoracoscopic surgery were reviewed retrospectively. Thirty-one patients (17.4%) including 35 nodules underwent thoracoscopic resection immediately after computed tomography–guided localization using hook wires. Criteria for preoperative localization were (1) maximum diameter of the nodule of 5 mm or less, (2) maximum diameter to minimum distance between the visceral pleura and inferior border of nodule of 0.5 or less, and (3) nodule with low-density image by computed tomography after chemotherapy. The accuracy of these inclusion criteria was statistically evaluated. Results All 224 nodules were removed by wedge resection or additional segmentectomy. Nineteen nodules (54.3%) were detected in the thoracic cavity with preoperative localization. Sensitivity, specificity, positive predictive value, and negative predictive value were 11.1%, 99.5%, 66.7%, and 92.8%; 88.9%, 93.2%, 53.3%, and 99.0%; and 88.9%, 90.8%, 45.7%, and 98.9% in each preoperative finding of which a nodule met all (3 nodules), two or more (30 nodules), and one or more (35 nodules) of the three criteria, respectively. Conclusions This study suggests that preoperative localization should be considered before video-assisted thoracoscopic surgery operation if the pulmonary nodule meets two or more of our criteria.
Objective The purpose of this study was to determine the implication of idiopathic pulmonary fibrosis on the surgical treatment for primary lung cancer. Methods Between January 1994 and June 2006, ...870 patients with primary lung cancer were surgically treated. Fifty-six (6.4%) of 870 patients had complications with idiopathic pulmonary fibrosis, and their data were retrospectively reviewed. There were 50 men and 6 women with an average age of 68 years. The incidence of squamous cell carcinoma was 28 (50.0%). Surgical procedures consisted of 7 wedge resections of the lung, 5 segmentectomies, 43 lobectomies, and 1 bilobectomy. Results Surgery-related hospital mortality was higher in patients with idiopathic pulmonary fibrosis than in patients without (7.1% vs 1.9%; P = .030). Four (7.1%) of these 56 patients had acute postoperative exacerbation of pulmonary fibrosis and died because of this complication. No factors such as pulmonary function, serologic data, operative data, and histopathologic data were considered predictive risk factors for the acute exacerbation. The postoperative 5-year survival for pathologic stage I lung cancer was 61.6% for patients with idiopathic pulmonary fibrosis and 83.0% for patients without ( P = .019). The causes of late death were the recurrence of cancer or respiratory failure owing to idiopathic pulmonary fibrosis. Conclusions Although idiopathic pulmonary fibrosis causes high mortality after pulmonary resection for lung cancer and poor long-term survival, long-term survival is possible in patients with these two fatal diseases. Therefore, in selected patients, idiopathic pulmonary fibrosis may not be a contraindication to pulmonary resection for stage I lung cancer.
Abstract We report a rare case of progressive hearing loss after acquired CMV infection in a child with Langerhans cell histiocytosis (LCH). A 5-month-old female was diagnosed as having LCH. When she ...was 14 months old, she received an unrelated donor umbilical cord blood transfusion for the treatment of intractable LCH. CMV infection was confirmed after the blood transfusion. Because her own umbilical cord had no CMV, the CMV infection was not congenital. When she was 7 years old, mixed hearing loss was noted with bilateral otitis media with effusion. After that time, the sensorineural hearing loss progressed to bilateral profound hearing loss over 3 years. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging with gadolinium contrast enhancement revealed a high intensity area in the inner ear that suggested bilateral labyrinthitis. This case demonstrates the possibility that, under the immunodeficiency, the acquired CMV infection causes progressive sensorineural hearing loss.
Objectives To elucidate whether fluorine-18-labeled (18 F) fluoro-2-deoxy- d -glucose (FDG) accumulation can reflect the extent of periodontal inflammation, periapical inflammation, or dental caries. ...Study Design18 F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) were retrospectively compared with the size of the bone resorption areas caused by periodontal inflammation, periapical inflammation, or dental caries on panoramic radiographs, CT, and magnetic resonance imaging (MRI) in 44 subjects. Results A significant correlation was found between the size of the bone resorption area caused by periodontal ( r = 0.595, P < .01) or periapical ( r = 0.560, P < .01) inflammation and the highest standardized uptake value (SUVmax) of18 F-FDG accumulation. A significant correlation was found between the periodontal ( r = 0.622, P < .01) or periapical ( r = 0.394, P < .01) inflammatory findings on MRI and the SUVmax of18 F-FDG accumulation. The SUVmax of18 F-FDG around most teeth with caries was under 1.5. Conclusions18 F-FDG accumulation reflects the extent of dental inflammation, not dental caries.
Abstract The presence of an earlobe crease (ELC) may be a simple sign to predict atherosclerosis. We evaluated the relationship between ELC and vascular function. We measured flow-mediated ...vasodilation (FMD) and nitroglycerine-induced vasodilation (NID) and observed bilateral earlobes in 400 consecutive subjects. At first, the subjects were divided into 3 groups: non-ELC group, unilateral ELC group and bilateral ELC group. FMD and NID were significantly lower in the unilateral and bilateral ELC groups than in the non-ELC group. After adjustment of cardiovascular risk factors, bilateral ELC, but not unilateral ELC, was associated with lower FMD and lower NID. We also investigated whether an increase in the number of ELCs worsens endothelial function, whether the difference in ELC structure (cross stripes and/or ramification) affects endothelial function, and whether endothelial function is impaired in subjects with superficial wrinkles depending on age. Number of ELCs, shape of the ELC, and superficial wrinkles were not associated with endothelial dysfunction. In conclusion, these findings suggest that the presence of bilateral ELCs is associated with vascular dysfunction.
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