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Postoperative pulmonary complications (PPCs) most commonly occur after thoracic surgery. Not only prolonged hospital stay and increased financial expenses but also morbidity and even mortality may be troublesome for those with PPCs. Herein, we aimed to conduct a comprehensive systematic review and meta-analysis of available data to examine the effectiveness of incentive spirometry (IS) to reduce PPCs and shorten hospital stay. This systematic review and meta-analysis included 5 randomized controlled trials (RCT) and 3 retrospective cohort study (10,322 patients in total) in PubMed, Embase and Cochrane Library until September 31, 2021. We assessed the clinical efficacy of IS using length of hospital stay, PPCs, postoperative pneumonia, and postoperative atelectasis with meta-analysis, meta-regression and trial sequential analysis (TSA). With this meta-analysis, the length of hospital stay in patients undergoing IS was significantly shorter (1.8 days) than that in patients not receiving IS (MD = -1.80, 95% CI = -2.95 to -0.65). Patients undergoing IS also had reduced risk of PPCs (32%) and postoperative pneumonia (17.9%) with statistical significance than patients not undergoing IS (PPC: OR = 0.68, 95% CI = 0.51-0.90) (Pneumonia: OR = 0.821, 95% CI = 0.677-0.995).In meta-regression, the benefits of undergoing IS in patients with preoperative predicted FEV

Lung ischemia-reperfusion (I/R) injury plays an important role in lung transplantation. Less well known is the role of sildenafil in lung I/R injury; therefore, we attempted to determine whether sildenafil could alleviate lung apoptosis and tissue injury in a rat model.Forty male Sprague-Dawley rats were randomized into four groups: saline + sham, saline + I/R, sildenafil + sham, and sildenafil + I/R groups. Three hours before the operation, each rat received normal saline or sildenafil (10 mg/kg) by lavage. The animals designed to I/R injury were subjected to 2 h of ischemia induced by occlusion of left pulmonary artery, veins, and bronchus, followed by reperfusion for 2 h. The lung tissue was harvested for the analysis of the expression of Bax, Bcl-2, p53, caspase 3, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and wet/dry (W/D) weight ratio.Compared with the saline + sham group, the saline + I/R group had significant increases in Bax, p53, Bax/Bcl-2 ratio, caspase 3, IL-6, TNF-α, and W/D weight ratio but a decrease in Bcl-2 (P0.05). Compared with the saline + I/R group, sildenafil + I/R group had significant decreases in Bax, p53, Bax/Bcl-2 ratio, caspase 3, IL-6, TNF-α level, and W/D weight ratio but an increase in Bcl-2 expression (P0.05). Compared with the sildenafil + sham group, there were significant increases in p53 and TNF-α expression in the sildenafil + I/R group (P0.05).Pretreatment with sildenafil alleviates lung apoptosis and tissue injury in a rat model.

Intrathoracic tumor is a rare entity in the pediatric population and neurogenic tumors account for 40-50% of childhood intrathoracic tumors. They can cause severe symptoms, such as respiratory distress, neurological dysfunction and metabolic disturbances. Posterior mediastinal ganglioneuroma (GN) usually occurs in children and can be found accidentally. Precise preoperative diagnosis is very difficult and has a great influence on surgical intervention. Here, we report a 6-year-old girl with a posterior mediastinal GN that was found incidentally on chest radiography. Computed tomography and magnetic resonance imaging demonstrated a right paraspinal tumor with punctuate calcification and intraspinal extension. 18 F-fluorodeoxyglucose positron emission tomography revealed low-grade fluorodeoxyglucose avidity of this tumor. Computed tomography and magnetic resonance imaging can characterize GN and positron emission tomography is helpful for differentiating benign or malignant lesions.

Background and Aims This study prospectively recruited esophageal squamous cell carcinoma patients who received esophageal stent, nasogastric tube (NGT), or jejunostomy/gastrostomy feeding to compare the changes in nutritional status and quality of life during chemoradiation therapy (CRT). Methods In total, 81 patients were analyzed (stent, 7; surgical ostomy, 26; NGT, 19; oral intake, 29). An NGT was inserted when, despite medication, dysphagia or pain worsened with oral feeding during CRT. Serial body weight and daily narcotic demand were recorded. Changes in serum albumin level and quality of life were also assessed. In subgroup analysis comparing NGT and prophylactic surgical ostomy feeding, 5 patients with total occlusion in the ostomy group were excluded. Results Patients in all groups had similar decreases in mean body weight with an overall change of –6.41% ± 5.21% at the end of CRT. The stent group had significantly worse pain, decreased albumin (–1.03 ± .9 mg/dL), and decreased quality of life across CRT compared with the other groups. In subgroup analysis the stent group had significantly higher weight loss, whereas the NGT group had higher narcotic demand and slightly worse quality of life. Two patients (7.7%) had ileus days after jejunostomy creation. Five patients (23.8%) among those received prophylactic ostomy creation and scarcely used it. Conclusions These preliminary results raise concerns that use of esophageal stents may be less suitable in patients undergoing CRT. Tube feeding by means of transnasal or percutaneous routes appear to be comparably effective during CRT, but both have advantages and disadvantages. We suggest a careful endoscopic evaluation to select the population more appropriate for NGT feeding on an as-needed basis during CRT.

Objective The main objective of this study was to further elucidate the effect of consuming various foods on the development of squamous cell carcinoma (SCC) in three different sections of the esophagus. Methods A total of 343 patients with SCC of the esophagus and 755 cancer-free control subjects were recruited for this study from 1996 to 2005. Results We found that intake of vegetables, raw onions/garlic, and fruits are significantly protective against esophageal SSC risk, whereas intake of hot foods can significantly increase its risk. There was a significant inverse relation between the frequency of tea consumption and esophageal SCC risk ( P for trend = 0.005), with a 0.5-fold lower risk associated with the intake of unfermented tea (green tea, oolong tea, or jasmine tea). The effects of dietary factors on esophageal SCC were similar in all subsites, with the exception of consumption of coffee. Coffee consumption was more pronounced in having a protective effect in the middle third section compared with the lower third section of the esophagus (adjusted odds ratio 0.4, 95% confidence interval 0.2–0.9), although this protective effect was marginally significant (adjusted odds ratio 0.6, 95% confidence interval 0.4–1.0) against esophageal SCC in all subsites. Our data also suggest that discomfort when eating hot foods may exert a carcinogenic effect by direct contact with the esophageal mucosa and tend to have more harmful effects in the upper than in the lower esophagus. In contrast, vegetables, fruits, and tea with components that are thought to inhibit carcinogenesis by absorbed components affected all subsites similarly. Conclusion Our results add additional information that certain dietary components may affect carcinogenesis locally and systemically.

Traditionally, Tc 99m methyl diphosphate (MDP) bone scintigraphy provides high-sensitivity detection of skeletal metastasis from breast and lung cancers in regular follow-up. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), based on the glucose metabolism of malignant cells, plays a role in describing tumor growth, proliferation of neoplasm and the extent of metastasis. In general, concordant findings of skeletal metastasis are seen on both types of image, especially in cases of breast and lung cancer. However, there were extremely discordant findings of skeletal metastasis between bone scans and F 18 FDG PET/CT imaging in two cases among 300 consecutive F 18 FDG PET/CT follow-up exams of patients with malignancies, during the past year, in our center. Both cases, one of breast cancer and one of lung cancer, had negative bone scintigraphic findings, but a diffusely high grade of F 18 FDG avid marrow infiltration in the axial spine, leading to the diagnosis of stage IV disease in both cases. Owing to variant genetic aberrance of malignance, F 18 FDG PET/CT reveals direct evidence of diffuse, rapid neoplasm metabolism in the bone marrow of the spine, but not of secondary osteoblastic reactions in vivo . F 18 FDG PET/CT should always be employed in the follow-up of patients with malignancies.

Compensatory hyperhidrosis (CH) is the most troublesome side effect after T2 sympathectomy for palmar hyperhidrosis (PH). The aim of this study was to evaluate whether T4 ganglion interruption for PH is an effective approach that can simultaneously minimize the rate of CH. Between July 2001 and July 2003, 84 PH patients undergoing bilateral thoracoscopic T4 sympathectomy were followed up in the outpatient clinic and by telephone questionnaire. Rates of success, regret, CH, recurrence, and complications were recorded. The follow-up period ranged from 18 to 42 months. All excessive hand sweating was stopped. Only two patients had mild CH that did not affect their daily activities. No patients had recurrence or regret. The only other complication was that four patients had postoperative minimal residual pneumothorax, which needed no treatment. All patients were satisfied with the outcome. T4 sympathectomy was an effective method to cure PH. The success rate was 100%. The rate of CH was remarkably low compared with T2 sympathetic ganglionic interruption.

Malignant smooth muscle tumors usually develop in the uterus and gastrointestinal tract due to the abundance of smooth muscle. They rarely develop in the soft tissue of the mediastinum. We report a 44-year-old male with neurofibromatosis type I who suffered from leiomyosarcoma extending between the left supraclavicle and the left-side middle mediastinum. The patient received debulking surgery to salvage the compromised airway and disabled upper limb. He then refused adjuvant therapy and expired 7 months postoperatively due to recurrence. To our knowledge, this type of case has never been reported in the literature.

Spontaneous pneumothorax is a rare manifestation of primary lung cancer or metastasis. We report a 39-year- old man with well-differentiated squamous cell carcinoma of the tongue and cervical lymph node metastases. He developed lung metastases and spontaneous pneumothorax 22 months later after intra-arterial infusion chemotherapy. The patient was managed with partial lung resection under thoracotomy. The pneumothorax resolved completely after the operation. Histological examination demonstrated metastatic squamous cell carcinoma, which had led to a bronchopleural fistula with subsequent induction of pneumothorax. The patient recovered uneventfully and continued to receive adjuvant chemotherapy in the oncology surgery outpatient department. Unfortunately, the tumors of the tongue and cervical lymph nodes progressively enlarged despite treatment. Eventually, the patient died of respiratory failure 5 months later. In most of the previously reported cases, pulmonary metastases associated with spontaneous pneumothorax usually originate from osteogenic or soft-tissue sarcomas. Although rare, pulmonary metastasis should be considered in the etiology of spontaneous pneumothorax. Despite advanced disease, surgical treatment may be feasible.

Primary spontaneous hemopneumothorax is a rare disorder but can be life-threatening secondary to massive bleeding. The authors encountered an uncommon case of left primary spontaneous hemopneumothorax and simultaneous right pneumothorax. After initial bilateral tube thoracostomies, successful 1-stage bilateral video-assisted thoracic surgery (VATS) was performed before the condition deteriorated or complications occurred. Active oozing from a ruptured vascularized bulla was identified at the apex of the left upper lobe. One-stage bilateral VATS appears to be a reasonable method of surgical intervention, but in patients under life-threatening clinical conditions, it may still be difficult to use this strategy, and a staged operation may be considered.

Study objectives Although videothoracoscopic (VTS) resection of Masaoka stage I thymoma has been reported to be a less invasive method than open thoracotomy and to achieve a comparable surgical outcome, the usefulness of this method in the treatment of stage II thymoma has not yet been prospectively evaluated. We therefore compared the VTS and open (median sternotomy) methods to see whether VTS resection could be used as successfully to treat stage II thymoma disease. Design, setting, and patients Patients (11 women and 11 men) with stage II thymoma were prospectively enrolled between November 1999 and September 2004. Of these, 12 patients (the VTS group) underwent tumor resection using a three-port endoscopic technique, and 10 patients (the open group) underwent tumor excision using a standard sternotomy approach. The diagnosis of all resected thymoma lesions and their stage were confirmed by histopathogic examination. Measurements and results Neither group experienced mortality or any major morbidity. The difference in mean age (± SD) between the VTS and open groups (40.2 ± 16.3 years and 47.7 ± 8.5 years, p = 0.202); mean operation time (193.3 ± 79.6 min and 207.5 ± 85.8 min, p = 0.692); mean duration of pleural drainage (4.2 ± 2.1 days and 4.6 ± 2.1 days, p = 0.702); and mean duration of postoperative hospital stay (6.8 ± 2.3 days and 8.9 ± 4.4 days, respectively; p = 0.157) were not statistically significant. However, mean intraoperative blood loss amounts were statistically different (119.2 ± 70.6 mL and 238.5 ± 110.2 mL, respectively; p = 0.006). During the mean follow-up period of 33.9 ± 19.7 months, all patients survived without sign of recurrence, and the mean survival time was not statistically significant (32.3 ± 22.0 months and 35.8 ± 17.5 months, respectively; p = 0.686). Conclusion Using careful and skillful technique, the VTS method is an effective treatment of stage II thymoma.

A 50-year-old man presented with a middle and posterior mediastinal mass on chest radiograph and computed tomography. Surgical exploration revealed a large dumbbell-shaped lipomatous lesion. Histologic examination confirmed this to be a fibrolipoma. This is the first reported case of fibrolipoma in the mediastinum but outside of the esophagus.

According to many published clinical trials, both haematological and non-haematological toxicities resulting from pemetrexed were relatively mild and therefore this drug is considered to be well tolerated. We came across a 60 y/o woman patient with stage IV adenocarcinoma, suffered from unexpected life threatening complication, rhabdomyolysis. Severe lower leg weakness and respiratory failure occurred on the day 3 after pemetrexed administration. To the best of our knowledge, this is the first report that addresses severe and life-threatening rhabdomyolysis which occur during chemotherapy for the treatment of lung cancer. We believed pemetrexed is a safe drug but we should pay attention to possible complications related to pemetrexed-based treatment and to also treat the life-threatening disorder of rhabdomyolysis immediately to prevent further damage.