Background: Pneumonectomy is associated with higher early mortality and morbidity, and it is also known to predispose the patient to respiratory complications during mid- and long-term follow-up. Therefore, the purpose of this study was to identify risk factors associated with respiratory complications during the follow-up period after pneumonectomy.Methods: We retrospectively reviewed 98 patients who underwent pneumonectomy for non-small cell lung cancer (NSCLC) between Jan 1995 and Dec 2005 Univariate and multivariate analyses were used to identify risk factors of late respiratory complications among preoperative and intraoperative data.Results: The median follow up duration of 98 patients was 33.1 months(4.2-180.0 months). The late mortality rate was 68.4% (n = 67). Causes of late death were cancer specific in 37 patients (55.2%) and respiratory specific in 25 patients(37.3%). Compared with 59 patients who had no respiratory infection after pneumonectomy during mid- or long-term follow-up, being male, a lower BMI (<22 kg/m²), presence of chronic obstructive pulmonary disease (COPD) and preoperative pneumonia were significant risk factors by univariate analysis. Multivariate analysis revealed that presence of preoperative pneumonia was the only independent factor associated with late mortality from respiratory complications during the mid- and long-term follow-up periods (OR = 2.41, 95% CI = 1.10−5.32, p = 0.028).Conclusion: Respiratory infection was a comparable risk factor of mortality in the mid- and long-term after pneumonectomy with cancer recurrence. The presence of preoperative pneumonia was an independent factor related to respiratory infection.Careful follow-up for these patients may be required.

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Purpose: We retrospectively reviewed our experience of surgical resection for second primary lung cancer (SPLC) in our institute. And to clarify whether periodic follow-up after resection of first primary lung cancer (FPLC) is associated with earlier detection of SPLC.Methods: From January 2003 to March 2011, a total of 386 patients underwent surgical resection for primary lung cancer in our institute. Of these patients, 21 (5.4%) with SPLC were observed during follow-up after surgery. Radiation therapy was selected instead of surgical resection in 7 patients to preserve respiratory function. The other14 patients are reviewed in this paper.Results: Histological types were different between FPLC and SPLC in only one patient(FPLC: adenosquamous carcinoma, SPLC: squamous cell carcinoma). The average SPLC tumor size (18±8 mm) was smaller (P = 0.07) than the average FPLC tumor size (26±14 mm). Recurrence was not observed in these patients.The follow-up period after resection of SPLC was 31±30 (5-94) months. During followup, 2 patients died of de novo malignancies, and the other 12 patients were alive without recurrence.Conclusion: Systematic and periodic long-term follow-up after FPLC probably resulted in earlier detection of SPLC and yielded this good prognosis.

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Purpose: Increased numbers of patients with both lung cancer and atherosclerotic vascular disease (AVD) may be expected in the future. The aim of this study was to report the incidence of lung cancer in patients with AVD and to discuss patient characteristics and management.Method: A total of 638 patients who underwent AVD treatment were investigated.Results: Lung cancer was observed in 17 (2.7%) of 638 patients studied. The proportion of smoking history was significantly higher in patients with lung cancer (p = 0.0091).The pack-year index in patients with lung cancer was significantly higher than that in patients without lung cancer (p = 0.0073). Although 4 of 6 (66.7%) patients with concomitant lung cancer and AVD had stage I or II lung cancer, 5 of 7 (71.4%) patients with lung cancer diagnosed after AVD treatment had stage III or IV lung cancer. In patients with lung cancer found after AVD treatment, only 1 of 7 patients underwent surgical resections. The time until lung cancer was 12 to 198 months with a mean of62.5 months after AVD treatment. In concomitant cases, priority was given to AVD treatment in all 5 cases, and there were no serious events after the postoperative course.Conclusions: Both patients with a smoking history and heavy smokers were at high risk for lung cancer, and most lung cancers found after AVD treatment were in the advanced stages and had poor prognoses. Therefore, we recommend careful and routine follow-up for screening lung cancer after AVD treatment.

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Purpose: The purpose of this retrospective study was to evaluate common clinicopathological factors and clarify the prognostic factors of small-sized peripheral-lung squamous cell carcinomas.Methods: We retrospectively reviewed 71 patients with peripheral squamous cell carcinoma ≤3 cm in diameter, who were surgically treated between January 1989 and December 2010. Patients undergoing partial lung resection without lymph node dissection were excluded. The median follow-up for living patients was 63 months.Results: The overall 3- and 5-year survival rates were 83.9% and 74.7%, respectively.Although the ROC curve of serum carcinoembryonic antigen (CEA) levels showed marginally significance (P = 0.050), multivariate analyses revealed that age (P = 0.043), lymph node metastasis (P = 0.004), and preoperative serum carcinoembryonic antigen (CEA) level (P = 0.037) were independent prognostic factors. For pathologic N0 patients, there was a significant difference for recurrence-free survival based on CEA levels: patients with normal CEA levels (n = 40), 5-year-recurrence-free rate = 93.5%;elevated CEA (n = 14), 5-year-recurrence-free rate = 72.7% (P = 0.0160). The distribution of tumor cells immunoreactive for CEA was significantly associated with serum CEA levels (P = 0.033).Conclusion: Age, lymph node metastasis, and serum CEA level are independent prognostic factors for small-sized peripheral-lung squamous cell carcinoma.

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Purpose: Pleurodesis continues to play a central role in the management of pneumothorax. In our institute, a 50% glucose solution is used for pleurodesis. We retrospectively analysed the treatment effects of pleurodesis in patients with spontaneous pneumothorax in whom an operation was contraindicated because of underlying disease.Methods: 13 patients (18 cases) with spontaneous pneumothorax were treated with pleurodesis with a 50% glucose solution. After local anesthesia of parietal pleura, 200 to500 mL of a 50% glucose solution was instilled into the pleural space. Pleurodesis was repeated two or three times, until the air leakage stopped.Results: Air leakage stopped in all cases and there were no treatment-related deaths.Overall survival rates at 1, 2, and 3 years after treatment were 83%, 74%, and 49%, respectively. Post-treatment recurrence was observed in six cases. Four cases of recurrence were treated with pleurodesis with a 50% glucose solution. All cases of recurrence occurred within 3 months after pleurodesis.Conclusion: Pleurodesis with a 50% glucose solution is effective and safe in patients with pneumothorax. This procedure can be performed in patients with recurrent pneumothorax as well as patients with a first episode of pneumothorax in whom prolonged air leakage is predicted.

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Purpose: The aim of the present study was to fixate displaced sternum fractures with a nonspecific plate, without a sternotomy procedure.Method: Between May 2010 and December 2011, 15 patients with sternal fractures were included in this study. We performed fixation for 8 of 15 sternal fracture patients.Posteroanterior and lateral chest x-rays and computed tomography were taken for diagnosis of sternal fractures. Our surgical indications were severe pain, dislocationoverlapping of sternal edges, and thoracic wall instability. Locked volar distal radius plates were used for the sternal fixation.Results: After fixation of sternum with plate, the sternum was stable in all 8 patients.There were no complications intra- or postoperatively. Sternal union was observed for all. Pain relief was determined dramatically.Conclusion: Locked volar distal radius plates can be used for displaced sternal fractures.It is an alternative and successful method for sternal fractures.

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Purpose: Few recent studies have examined the long-term outcomes after aortic valve replacement (AVR), and independent predictors for long-term survival and valve-related mortality have not been elucidated.Methods: From January 1993 to December 2009, 132 elderly patients (≥70 years old) with aortic stenosis underwent AVR in our hospital. The patients comprised 61 men and71 women with a mean age of 76.1 ± 3.7 years. Patients with acute or old myocardial infarction, mitral valve disease, and re-do surgery were not included in this study. Risk factors for late valve-related mortality were examined.Results: The 5-year freedom from valve-related mortality rate was 89.6%. The following significant independent risk factors for late valve-related mortality were identified:increase in the preoperative left ventricular mass index (hazard ratio, 1.10 [per 10 g/m²];p = 0.040); lack of sinus rhythm (hazard ratio, 7.11; p = 0.005); peak transvalvular pressure gradient of <60 mmHg (hazard ratio, 7.48; p = 0.008).Conclusion: In the elderly, AVR should be performed at an early stage of aortic stenosis, before an increase in the left ventricular mass index has occured, and while the heart rhythm is in sinus rhythm and the peak transvalvular pressure gradient is high.

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Objective: N-terminal pro-B type natriuretic peptide (NT-pro-BNP) is one of the biomarkers, increased by myocardial ischemia or subsequent, burdened wall stress. The aim of this study was to assess if NT-pro-BNP can predict the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB).Methods: NT-pro-BNP was measured preoperatively in 100 OPCAB patients without preoperative AF. Patients were divided into the AF group (n = 36) of those who developed postoperative AF, and the sinus rhythm (SR) group (n = 64), of those who did not.Odds ratio analysis was carried out with a logistic regression model using the threshold of the high quartile.Results: Age was more advanced in group AF (70.8±8.7 years old) than in group SR(66.7±8.5 years old), P = 0.025. There were more emergencies in group AF (22.2%) than in group SR (10.9%), P = 0.15. Preoperative NT-pro-BNP was significantly higher in group AF (509.6±641.6 pg/mL) than in group SR (241.1±302.7 pg/mL), P = 0.006.Preoperative administration of statins was relatively greater in group SR (73.4%) than in group AF (58.3%), P = 0.18. Four factors withaPvalue below 0.2 in the univariate analysis were extracted, which were preoperative administration of statins, emergency, high NT-pro-BNP (>348 pg/mL, high quartile), and advanced age (>75 years old, high quartile). The constructed logistic regression model revealed that high NT-pro-BNP(>348 pg/mL, high quartile) was the only predictor of postoperative AF after OPCAB(P = 0.05; OR, 2.60; 95% CI, 0.96-7.05).Conclusions: A high preoperative level of NT-pro-BNP could predict the incidence of postoperative AF after OPCAB.

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We report the case of an extremely elderly patient with long-term survival after surgical resection for lung cancer. A 93-year-old man was evaluated for an abnormal density on chest radiography. Chest computed tomography (CT) showed a nodular density of 2.5 × 2.5 cm in the left S4b segment. Lung cancer was diagnosed by bronchoscopy, and left posterolateral thoracotomy and S4 segmentectomy were performed. Group 1 lymph node dissection and sampling of the 6th lymph node were also performed. Pathological examination revealed poorly differentiated squamous cell carcinoma without any lymph node metastases. The tumor was staged as p-T1aN0M0 stage IA. No complications were encountered postoperatively, and the patient was discharged. He remains alive as of 5 years postoperatively without any recurrence.

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A 69-yrs-old woman with anomalous origin of the right coronary artery from the opposite sinus of Valsalva (ACAOS) was diagnosed as having infective endocarditis affecting the aortic valve. Transthoracic echocardiography showed severe aortic stenosis and vegetations on the cusp of the aortic valve, which necessitated aortic valve replacement. Before the operation, computed tomography showed a right-ACAOS, with the artery running an interarterial course between the aorta and pulmonary artery. ACAOS running an interarterial course has been reported to be associated with an increased risk of ischemic cardiac events and sudden death. The patient was treated successfully by the aortic valve replacement with concurrent coronary artery bypass grafting using a saphenous vein graft for the right coronary artery.

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A 63-year-old male patient with subaortic stenosis (Pmax 105 mmHg, Pmean 55 mmHg) and an aneurysm of the ascending aorta was referred to our hospital due to progressive angina pectoris. Transesophageal echocardiography demonstrated high and turbulent subaortic flow velocities. A calcified subaortic membrane was identified. The membrane was removed and the aneurysm was treated with a Bentall procedure. The patient recovered smoothly from surgery and was doing well 6 months after discharge.

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We present a patient with ruptured suprarenal aortic aneurysm, involving origins of visceral and renal arteries. Associated spondylodiscitis and left psoas muscle abscess were also diagnosed. The patient was initially treated with antibiotics. Diagnostic survey showed progression of the aneurysm diameter and enlargement of the psoas muscle abscess. Surgical treatment using a cryopreserved aortic homograft with debranching of visceral arteries was performed. Different modalities of surgical repair within the infected aortic segment and the rationale for usage of cryopreserved homografts are considered. The importance of optimal timing for surgery is emphasized as well.

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