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Surgical manipulation of paraganglioma can induce a massive release of catecholamines leading to hypertensive attack. But it has been not known about risk factors to cause hypertensive attack because paragangliomas of urinary bladder and retroperitoneum are notably rare tumors and have been recorded as case report or series. We investigated the relationship between mass size and hypertensive attack during surgery in patients with paraganglioma.Our retrospective chart review included 32 patients who had a pathological diagnosis of paraganglioma between March 2006 and May 2021, in single center. We analyzed the risk factors such as age, sex, height, weight, blood pressure before surgery, history of hypertension, pre-operative symptoms, mass location, and mass in 24 patients with retroperitoneal paragangliomas including urinary bladder. Hypertensive attack was defined as systolic blood pressure180 mmHg during excision of the mass from the electric medical chart. The predictive power was assessed by the area under the curve of the receiver operating characteristic curve.There were 19 retroperitoneal, 5 urinary bladder, 2 middle-ear cavity, 2 mediastinal, 2 neck, 1 spinal cord and 1 duodenal paraganglioma. Seven (29.2%) of the 24 patients had preoperative symptoms such as pain, fluctuation of blood pressure, and palpable mass. Hypertensive attack during surgery occurred in 11 patients (45.8%). There was a significant difference in mass size between groups with (n=11) and without (n=13) fluctuation of blood pressure (P=0.007). The area under curve for predicting surgical complications according to mass size was 0.808 (cutoff size 4.25 cm, sensitivity 72.7%, specificity 76.9%, 95% CI: 0.635-0.981).Mass size impacted occurrence of hypertensive attack during surgery in patients with retroperitoneal paraganglioma. Surgeons have to be watchful regarding of intraoperative hypertension during resection of retroperitoneal masses exceeding 4.25 cm, which are suspected as paraganglioma.

This study aimed to compare the lymph node core tissue lengths obtained via mediastinal or hilar lymphadenopathy using the complementary "rotation aiding" and conventional Jab technique.We prospectively measured the lymph node core tissue length in patients who sequentially underwent the Jab and rotation aiding (RA) techniques between October 2012 and December 2014. Wilcoxon signed-rank test was used to compare the core tissue length and grade of diagnostic cells obtained by each technique. McNemar's test was used to compare the proportion of adequate cellularity (≥grade 2) between the aspiration techniques.The core tissue length of 61 lymph nodes from 43 patients (mean age: 63 years, range: 16-86 years) was analyzed. Pathological findings were consistent with malignant lesions in 25 (41%) patients and benign lesions in 36 (59%). The most common diagnosis in benign lymph nodes was reactive, followed by tuberculosis and sarcoidosis. We obtained longer core tissue with RA technique than with the Jab technique (83.2 ± 12.7 vs. 60.1 ± 10.1 mm; p = 0.02). There was a significant increase in cellularity grade and proportion of ≥grade 2 cells with the RA technique than with the Jab technique (2.39 ± 1.08 vs. 1.84 ± 1.14; p 0.001, 78.7% vs. 52.5%; p = 0.002), regardless of the pathological diagnosis.RA technique facilitated more lymph node samples in terms of core tissue length and cellularity than the Jab technique.

O-GlcNAc Transferase (OGT) is a complementary enzyme that regulates O-linked N-acetylglucosaminylation(O-GlcNAcylation) and plays a critical role in various cancer phenotypes, including invasion, migration, and metabolic reprogramming. In our previous study we found that miR-7-5p was downregulated at lung cancer cells with highly metastatic capacity. In the in-silico approach, OGT is the predicted target of miR-7-5p. To identify miR-7-5p′s role in cell growth and metabolism, we transfected various lung cancer cell lines with miR-7-5p. The expression level of miR-7-5p was confirmed by qRT-PCR in lung cancer cell lines. Western blot assays and qRT-PCR were performed to demonstrate miR-7-5p′s effect. Bioinformatic analysis indicated that OGT is a direct target of miR-7-5p. The binding sites of miR-7-5p in the OGT 3′ UTR were verified by luciferase reporter assay. To investigate the role of miR-7-5p in the cancer metabolism of non-small cell lung cancer (NSCLC) cells, mimic of miR-7-5p was transfected into NSCLC cells, and the effect of miR-7-5p on cancer metabolism was analyzed by LDH assays, glucose uptake, and mitochondrial ATP synthase inhibitor assay. O-GlcNAcylated protein level was determined by Western blot. The role of miR-7-5p in lung cancer growth was measured by MTS assays. To identify the delivery of miR-7-5p via PLGA, an in vitro release assay of PLGA-miR-7-5p was done. miR-7-5p was highly expressed whereas OGT showed low expression in H358, H827. However, miR-7-5p exhibited low expression while OGT had high expression in H522, H460, and H1299 cell lines. OGT were repressed by binding of miR-7a-5p to the 3′-UTR. Overexpression of miR-7-5p also diminished anaerobic glycolysis. miR-181a-5p transfection induced expression levels of OGT were diminished compared to those in the control group. O-GlcNAcylation was suppressed by miR-7-5p. Moreover, the overexpression of miR-7-5a suppressed lung cancer cell growth. miR-7-5p was released via PLGA for up to 10 days. In the present study, inhibition of OGT by miR-7-5p decreased the growth and cancer metabolism of lung cancer.

We describe the occurrence of acute type A aortic dissection in a patient with situs inver-sus totalis. A 37-year-old man presented to the emergency department with acute chest pain. Initial chest X-ray findings showed a right-sided heart and a left-sided liver. Con-trast-enhanced computed tomography revealed a Stanford type A acute aortic dissection, aortic root dilatation, and situs inversus totalis. All of the thoracic structures were mirror-im-age reversed and an abnormal coronary artery was observed. The Bentall operation was performed. This report demonstrates that computed tomography and echocardiography were useful for understanding the anatomy and the presence or absence of concurrent anomalies in a patient with situs inversus totalis. The patient’s postoperative course was uneventful.

Background: Cancer stem cells (CSCs) identified in lung cancer exhibit resistance to chemotherapy, radiotherapy, and targeted therapy. Therefore, a technology to control of CSCs is needed to overcome such resistance to cancer therapy. Various evidences about the association between epithelial-mesenchymal transition related transcriptomic alteration and acquisition of CSC phenotype have been proposed recently. In our previous research, down-regulated miR-26a-5p is closely related to mesenchymal-like lung cancer cell lines. These findings suggest that miR-26a-5p might be involved in lung cancer stemness. Methods: RNA polymerase III subunit G (POLR3G) was selected as a candidate target of miR-26a-5p related to cancer stemness. its quantitative relationship was investigated by polymerase chain reaction, western blot after transfection of miR-26a-5p. luciferase assay were done for investigating the direct regulation of miR-26a-5p on POLR3G expression. After transfection of miR-26a-5p, colony formation assay and sphere formation assay were performed to evaluate the effect on cancer stemness. By treating cancer cell by miR-26a-5p and paclitaxel, cell viability was checked by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay and Muse cell analyzer. Expression level of each gene and its impact on survival were revealed by the cancer genome atlas pancancer database. Results: miR-26a-5p regulated the expression of POLR3G directly. Overexpression of miR-26a-5p induced down regulation of POLR3G and a marked reduction of colony formation and sphere formation. Co-treatment of miR-26a-5p with paclitaxel decreased cell growth, suggesting that miR-26a-5p might play a role as a chemotherapy sensitizer. In the cancer genome atlas data, down-regulated miR-26a-5p and up-regulated POLR3G were shown compared to adjacent normal tissue. High miR-26a-5p and low POLR3G expression were also related to higher survival rate of patients with lung adenocarcinoma. Conclusions: Overexpression of miR-26a-5p can suppress lung cancer stemness and make cancer cell become sensitive to chemotherapy. This finding provides a novel insight into a potential lung cancer treatment by regulating stemness. Citation Format: Daeun Kang, Chang Ryul Park, Minhyeok Lee, Su Yel Lee, Se Jin Park, Wan Jin Hwang, Gwan Woo Ku, Seong Lan Yu, In Beom Jeong, Sun Jung Kwon, Jaeku Kang, Eung Bae Lee, Ji Woong Son. microRNA-26a-5p is a prognostic factor that regulates cancer stemness [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 817.

Purpose: Malignant pleural effusion (MPE) is common in patients with advanced cancer. Chemical pleurodesis can be considered for MPE that do not respond to chemotherapy, radiotherapy, or therapeutic thoracentesis. However, it is not yet clear which agent is more effective and safer in chemical pleurodesis. Methods: This study was designed as a single arm, multicenter, and open-label phase III clinical trial to evaluate efficacy and safety of chemical pleurodesis using mistletoe extraction (ABNOVAviscum® Injection). References of other agents in chemical pleurodesis were investigated to compare efficacy and safety. Efficacy was evaluated by followed up chest X-ray and changes of clinical symptoms and Karnofsky performance scale. Safety was evaluated by serious adverse event (SAE) and changes of laboratory findings. A follow-up period was 4 weeks after last pleurodesis. Results: Of 62 patients, 49 (79.0%) had complete response, 11 (17.7%) had partial response, and two had no response. Mean response rate was significantly different in this study comparing with reference response rate which was 64% (p

The use of bronchoscopy is central to the diagnosis of lung cancer. However, the sensitivity of bronchoscopy is low. In addition, bronchial washing cytology, which is a routine adjunctive test, does not significantly improve the performance of bronchoscopy owing to its low sensitivity. To enhance the diagnostic performance of bronchoscopy, the protocadherin GA12 (PCDHGA12) methylation biomarker in bronchial washings was introduced as a novel adjunctive diagnostic test. A total of 98 patients who underwent bronchoscopy owing to suspicion of lung cancer were analyzed. Cytological examination and PCDHGA12 methylation biomarker testing of the bronchial washing fluid were performed. The performance of the tests was analyzed. The final diagnosis in 60 patients was lung cancer and in 38 patients was benign disease. The PCDHGA12 methylation biomarker had a sensitivity of 75.0%, a specificity of 78.9% and a positive predictive value (PPV) of 84.9%, whereas cytological assessment had a sensitivity of 45.0%, a specificity of 92.1% and a PPV of 90%. Patients with positive PCDHGA12 methylation test had an odds ratio for lung cancer of 11.25 (confidence interval, 4.25–29.8) compared with negative subjects. The combination of the two tests exhibited an increased sensitivity (83.3%), a specificity of 71.1% and a PPV of 82.0%. Furthermore, considering the non-diagnostic bronchoscopy group alone, the test demonstrated a sensitivity of 61.9% and a specificity of 78.9%. The results of the present study demonstrated that PCDHGA12 methylation, as a lung cancer biomarker in bronchial washings, may be a used as an adjunctive test to bronchoscopy.

Background and objectives We identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) followed by therapeutic hypothermia on survival and neurologic outcome in patients with prolonged refractory in-hospital cardiac arrest (IHCA). Methods We enrolled 16 adult patients who underwent ECPR followed by therapeutic hypothermia between July 2011 and December 2015, for IHCA. Survival at discharge and cerebral performance category (CPC) scale were evaluated. Results All patients received bystander cardiopulmonary resuscitation (CPR); the mean CPR time was 66.5±29.9 minutes, and the minimum value was 39 minutes. Eight patients (50%) were discharged alive with favorable neurologic outcomes (CPC 1-2). The mean follow-up duration was 20.1±24.3 months, and most deaths occurred within 21 days after ECPR; thereafter, no deaths occurred within one year after the procedure. Conclusion ECPR followed by therapeutic hypothermia could be considered in prolonged refractory IHCA if bystander-initiated conventional CPR is performed.

A 37-year-old woman was referred to our institution for further management of a mass lesion located in the thoracic cavity. The mass had grown by more than 10 cm over the course of a year and was initially considered to be a scar from previous pulmonary tuberculosis at another hospital. The patient had complained of left-sided flank pain for a year and experienced dyspnea for one month. Chest radiography and chest computed tomography revealed an irregular-shaped mass in the left mid to lower pleural cavity. The mass was widely excised through left thoracotomy. Pathologic examination of the biopsy specimen revealed a malignant spindle cell tumor, which consisted of components of osteosarcoma, pleomorphic sarcoma, and leiomyosarcoma. The patient underwent adjuvant chemotherapy and has been doing well without any evidence of recurrence for 14 months.

We hereby report a case on bronchogenic cyst which is initially non-infected, then becomes infected after bronchoscopic ultrasound (US)-guided transesophageal fine-needle aspiration (FNA). The non-infected bronchogenic cyst appears to be filled with relatively echogenic materials on US, and the aspirate is a whitish jelly-like fluid. Upon contrast-enhanced MRI of the infected bronchogenic cyst, a T1-weighted image shows low signal intensity and a T2-weighted image shows high signal intensity, with no enhancements of the cyst contents, but enhancements of the thickened cystic wall. The patient then undergo video-assisted thoracic surgery 14 days after the FNA. The cystic mass is known to be completely removed, and the aspirate is yellowish and purulent. To understand the image findings that pertain to the gross appearance of the cyst contents will help to diagnose bronchogenic cysts in the future.

To the Editor, The frequency of massive hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma (HCC) has been reported to be 10% to 18% because of the extensive vascular structure and relatively small amount of fibrous tissue in these tumors [1]. Hemothorax caused by rupture of a lung or pleural metastasis of HCC occurs less frequently. Although one case of cardiac tamponade caused by spontaneous rupture of a metastatic mediastinal lymph node (MLN) has been described [2], to our knowledge, no case of hemothorax due to spontaneous rupture of a metastatic MLN of HCC has been reported in the Korean- or English-language literature. We describe here a case of massive hemothorax due to spontaneous rupture of a metastatic MLN in HCC. A 60-year-old male Korean farmer was brought to the Department of Emergency, Ulsan University Hospital with dyspnea and left pleuritic chest pain within 6 hours after symptom onset. Six years earlier, he was diagnosed with chronic hepatitis B-related cirrhosis and 4 years earlier he had been diagnosed with HCC (Fig. 1A) and underwent a right hepatic lobectomy. Multiple metastatic pulmonary nodules were detected 3 months after the surgery and the patient received six cycles of a cisplatin-based chemotherapy regimen over 6 months. Contrast-enhanced computed tomography (CT) scanning showed complete disappearance of the multiple metastatic lung nodules after chemotherapy. At 8 months after finishing the chemotherapy, however, he was readmitted to our hospital due to a single metastatic nodule in the left lower lobe of the lung and underwent metastasectomy with video-assisted thoracoscopic surgery (VATS). Pathological examination of the lung nodule removed showed results consistent with metastatic HCC. Figure 1 Chest computed tomography scans showing (A) a 10-cm sized intrahepatic peripheral capsular enhanced mass, (B) a single enlarged lymph node (white arrow) in the left inferior pulmonary ligament, and (C) a 73 × 84-mm ruptured low-attenuated central ... At 1 year before admission, CT images of the chest showed a single enlarged lymph node (LN) in the left inferior pulmonary ligament, regarded as a metastatic MLN of HCC (Fig. 1B). Two weeks before this admission, follow-up CT images showed enlargement of the metastatic MLN, and the patient was scheduled for additional chemotherapy. On the day of admission, the patient experienced an abrupt onset of dyspnea and left pleuritic chest pain. Physical examination on admission revealed an acutely ill-looking man with body temperature of 36.5℃, pulse rate of 130 beats per minute, blood pressure of 100/70 mmHg, and a respiration rate of 32 breaths per minute. Laboratory test results included hemoglobin 12.3 g/dL, hematocrit 33.4%, white blood cell count 4.37 × 103/µL, platelet count 9.9 × 104/µL, aspartate aminotransferase 47 IU/L, alanine aminotransferase 60 IU/L, total bilirubin 2.0 mg/dL, albumin 3.2 mg/dL, and α-fetoprotein 819.2 ng/mL. Chest X-rays showed a massive left-sided pleural effusion, with the trachea deviated to the right side. Massive hemothorax was diagnosed by thoracentesis. CT images of the chest revealed a 73 × 84 mm-sized ruptured low-attenuated central necrotic mass with massive left side hemothorax (Fig. 1C). A chest tube was inserted and approximately 1,200 mL of bloody fluid was drained. Arteriography of the bronchial arteries revealed a massive ruptured LN in the left inferior pulmonary ligament, to which blood was supplied by an accessory bronchial artery originating 10 cm beneath the left bronchial artery. These findings indicated that the massive hemothorax was caused by a spontaneous rupture of a metastatic MLN of HCC into the intrapleural space. Transcatheter arterial embolization (TAE) of the left bronchial artery was performed successfully, injecting 13 mL of lipiodol ultraf luide (Guerbet, Aulnay-sous-Bois, France) and 30 mg of adriamycin (doxorubicin hydrochloride) with polyvinyl alcohol particles (contour emboli, Interventional Therapeutics Corp., Fremont, CA, USA) (Fig. 1D). No complication was observed and the pleural effusion gradually disappeared thereafter. The patient's dyspnea improved, as did his physical condition. Following removal of the chest tube, he was discharged after 15 days in the hospital and was followed monthly as an outpatient at the department of oncology for 3 months. Serial chest X-rays revealed a decrease in the size of the MLN with lipiodol embolization. Four months later, however, the patient died at home. Due to its vascular structure and relatively small amount of fibrous tissue, spontaneous rupture of HCC is not uncommon [1]. Rupture of HCC is considered a medical emergency and is associated with high mortality. HCC frequently metastasizes, most often to the lungs, LNs, bones, and adrenal glands. Moreover, HCC metastases, like the primary tumors, may rupture spontaneously. Sohara et al. [3] reviewed 10 cases with HCC complicated by hemothorax, including four case reports in Japanese, describing patients with metastasis to the chest wall and rib, lung, pleura, diaphragm, and MLN [4]. Those reports included the first case of hemothorax from spontaneous rupture of a mediastinal metastasis [4]. Common clinical presentations are chest pain and dyspnea initially [3]. Other signs are palpitations and hypotension, consistent with hypovolemic shock. Reported rare signs included massive hemoptysis and respiratory failure. Our patient also developed hemothorax with sudden-onset chest pain, dyspnea, and tachycardia. Ruptured HCC can be treated surgically or by TAE, with the latter now used widely for HCC ruptured into the peritoneal cavity. Masumoto et al. [5] first reported hemothorax due to HCC rupture successfully controlled by TAE and our case was also successfully controlled using TAE. On the other hand, surgically treated and untreated failures have been reported and drainage-only cases do allow complete control [3]. Our patient had been diagnosed with HCC 4 years earlier and had undergone various treatments, including right hepatic lobectomy, six cycles of chemotherapy for multiple lung metastases, VATS metastasectomy for a single metastasis in the lung, and TAE for rupture of metastatic MLN causing massive hemothorax. TAE was effective, in that bleeding was successfully controlled and pleural effusion did not recur. Our findings suggest that patients with HCC should be closely monitored and suitably managed to improve survival. In conclusion, this is the first report of hemothorax secondary to spontaneous rupture of metastatic MLN of HCC in the Korean- or English-language literature. The hemothorax was successfully treated with TAE. The various manifestations observed in patients with HCC suggest the need for careful monitoring and suitable management.

There are many ways to treat focal hyperhidrosis, including surgeries for palmar and axillary hyperhidrosis. However, doctors and patients tend to be reluctant to perform surgery for plantar hyperhidrosis due to misconceptions and prejudices about surgical treatment. In addition, few studies have reported the outcome of surgeries for plantar hyperhidrosis. Therefore, the objective of this study was to determine the outcome (early and late postoperative satisfaction, complication, compensatory hyperhidrosis, recurrence rate, and efficiency) of surgical treatment for plantar hyperhidrosis.From August 2014 to October 2015, lumbar sympathetic block (LSB) was performed in 82 patients with plantar hyperhidrosis using clipping method. Limited video-assisted LSB was performed using 5 mm ligamax-clip or 3 mm horizontal-clip after identifying L3-4 sympathetic ganglion through finger-touch and endoscopic vision.Of the 82 patients, 45 were male and 37 were female. Their mean age was 26.38 years (range, 14-51 years). Mean follow-up time was 6.60 ± 3.56 months. Mean early postoperative satisfaction score was 9.6 on the 10th day postoperative evaluation. At more than 1 month later, the mean late postoperative satisfaction score was 9.2. There was no significant difference in early postoperative satisfaction score between clipping level L3 and L4/5. However, late postoperative satisfaction score was significantly better in the L3 group than that in the L4/5 group. Patient's age and body mass index did not affect the satisfaction score. However, male patients and patients who had history of hyperhidrosis operation showed higher satisfaction score than others.Limited video-assisted LSB using clip provided good results with minimal complications and low compensatory hidrosis, contrary to the prejudice toward it. Therefore, surgical treatment is recommended for plantar hyperhidrosis.

Background The standard regimen in elderly patients with non-small-cell lung cancer (NSCLC) is still uncertain. Gemcitabine is one of the most widely used drugs for the treatment of NSCLC, and several phase II trials specifically designed for elderly patients with advanced NSCLC have confirmed the role of gemcitabine in this setting. In addition, oral uracil-tegafur (UFT) was associated with a survival advantage in the adjuvant setting. Therefore, we performed a phase II study using the combination of gemcitabine and UFT as first-line therapy in elderly patients with advanced NSCLC. Methods Chemotherapy-naive, elderly (≥70 years) patients who had histologically or cytologically confirmed with stage IIIB or IV NSCLC with a performance status of 1–2 were enrolled. Patients received gemcitabine (1250mg/m 2 on days 1 and 8, respectively) and UFT (400mg/day on days 1–14) every 3 weeks for up to four cycles. Patients who had not progressed after four cycles continued UFT monotherapy until progression. Primary endpoint was overall response rate and secondary endpoints were overall survival, time to progression and safety profiles. Results Between March 2008 and November 2010, 48 patients were enrolled. The median age was 74.5 years (range: 70–84 years), and there were 29 males. The performance status was 1 in 41 and 2 in 7 patients. Thirty-one (64.6%) patients were stage IV and seventeen (35.4%) patients were stage IIIB. Thirty patients (62.5%) completed four cycles of chemotherapy. Response was evaluated in 44 patients. Partial response was achieved in twelve (25.0%) patients and stable disease in 23 (47.9%) patients. Disease control rate was 72.9%. The median survival time was 6.1 months (95% confidence interval [CI]; 5.1–7.0 months), the 1-year survival rate was 29.1% and the median time to progression was 4.6 months (95% CI; 3.7–5.5 months). Toxicities were mild and mostly hematological adverse events. Grade 3/4 neutropenia occurred in 8.3% of patients and one patients experienced febrile neutropenia. Grade 3/4 anemia and thrombocytopenia occurred in 2.1% and 2.1% of patients, respectively. Non-hematological toxicities were tolerable. Conclusions The combination of gemcitabine and UFT was effective in disease control and well tolerated first-line regimen in elderly patients with advanced NSCLC.

Summary Purpose The standard chemotherapy for non-elderly patients with advanced non-small-cell lung cancer (NSCLC) is platinum-based doublet combination therapy. Preclinical and clinical evidence indicates that infusion at the fixed dose rate (FDR) of 10mg/(m 2 min) may be more effective than a standard 30-min infusion of gemcitabine. In addition, oral uracil-tegafur (UFT ® ) was associated with a survival advantage in the adjuvant setting. Therefore, we performed a phase II study using the combination of gemcitabine, cisplatin and UFT as first-line therapy in patients with advanced NSCLC. Patients and methods Eligible patients had histologically or cytologically confirmed stage IIIB or IV NSCLC with a performance status of 0–2 and were chemotherapy-naive. Gemcitabine (1250mg/m 2 , 10mg/(m 2 min) on days 1 and 8, respectively) and cisplatin (75mg/m 2 on day 1) were injected intravenously and UFT (400mg/day) was administered orally on days 1–14. Treatment was repeated every 3 weeks for up to six cycles. Primary endpoint was overall response rate and secondary endpoints were overall survival, time to progression and safety profile. Result Thirty-seven patients were enrolled. The median age was 60 years (range: 44–72 years). The performance status was 0 in 4, 1 in 30, and 2 in 3 patients. Twenty-three patients completed six cycles. Complete response was achieved in one (3%) patient, partial response in 17 (46%) patients, and stable disease in 10 (27%) patients. The overall response rate was 48.6% on an intention-to-treat basis and 54.5% of patients in whom a response evaluation was possible ( n =33). The median survival time was 14.7 months (95% confidence interval [CI] 11.2–18.2), the 1-year survival rate was 54% and the median time to progression was 5.4 months (95% CI 4.3–6.4). Toxicities were moderate and mostly hematological adverse events. Grade 3/4 neutropenia occurred in 37% of patients and four patients experienced febrile neutropenia. Grade 3/4 anemia and thrombocytopenia occurred in 19% and 5% of patients, respectively. Non-hematological toxicities were mild. Conclusion The combination of gemcitabine, cisplatin and UFT is an active and well-tolerated first-line regimen in patients with advanced NSCLC.

Malignant pleural effusion (MPE) is common in patients with advanced cancer. Chemical pleurodesis can be considered for MPE that do not respond to chemotherapy, radiotherapy, or therapeutic thoracentesis. However, it is not yet clear which agent is more effective and safer in chemical pleurodesis.This study was designed as a single arm, multicenter, and open-label phase III clinical trial to evaluate efficacy and safety of chemical pleurodesis using mistletoe extraction (ABNOVAviscum(®) Injection). References of other agents in chemical pleurodesis were investigated to compare efficacy and safety. Efficacy was evaluated by followed up chest X-ray and changes of clinical symptoms and Karnofsky performance scale. Safety was evaluated by serious adverse event (SAE) and changes of laboratory findings. A follow-up period was 4 weeks after last pleurodesis.Of 62 patients, 49 (79.0%) had complete response, 11 (17.7%) had partial response, and two had no response. Mean response rate was significantly different in this study comparing with reference response rate which was 64% (p0.0001). There were two SAEs, but all were recovered without sequelas.The results of this study suggest that mistletoe extraction (ABNOVAviscum(®) Injection) could be an effective and safe agent of chemical pleurodesis in patients with MPE.

Background : The aim of this study was to evaluate the response, survival, and toxicities of a less intensive combination of paclitaxel and carboplatin, which is used in advanced non-small cell lung cancer (NSCLC) patients older than 60 years of age including those with a poor performance status. Methods: Thirty patients received 135 mg/ of paclitaxel on day 1, and carboplatin was administered to the patients on day 1 every 4 weeks over an area under the concentration-time curve of 6. Results: The response rate was 40%, the median overall survival was 9.1 months (95% CI, 4.2 to 14 months), and the 1 year survival rate was 31 %. The median progression-free survival was 7.7 months (95% CI, 3.1 to 12.2 months), In addition, the toxicities were generally mild and reversible. Conclusion: This study demonstrates that a less intensive combination of paclitaxel/carboplatin is active and well tolerated in advanced NSCLC patients who are older than 60 years including those with a poor PS 34.

Rationale: A foregut duplication cyst (FDC) is an uncommon congenital disease. This report presents a case of mediastinal foregut duplication cyst that mimicked a diaphragmatic small bowel hernia. Patient concern: A 27-month-old girl was first referred for a mediastinal lesion found incidentally on a chest radiograph. At that time, our impression was cystic lung lesion such as congenital pulmonary airway malformation or pulmonary sequestration. At the age 6 years, she presented with recurrent vomiting. The physical examination and laboratory studies were within normal limits. Diagnoses: Chest CT revealed a thin- and smooth-walled cystic mass containing an air-fluid level in the left paravertebral space. It had several inner circular folds and characteristic double-layer enhancement and inner circular fold. Our radiological impression was a type I congenital cystic adenomatoid malformation. Interventions: The patients undergone video-assisted thoracoscopic surgery for excision. The operative finding was the cystic mass with smooth bowel-like outer surface and located between the aorta and heart. The cyst was excised and confirmed to be a foregut duplication cyst pathologically. Outcomes: The patient was doing well with no postoperative complications during follow-up. Recurrent vomiting was improved. This is the first case report describing foregut duplication cyst mimicking a small bowel hernia. Lessons: Foregut duplication cysts are rare congenital anomalies of primitive foregut origin. They can occur at any level of the alimentary track and comprise approximately 10% of all mediastinal tumors. Its characteristic double-layered histopathological nature, an FDC can show a double-layered enhancement pattern, which is typical in the alimentary tract.

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.

e20544Background: CD70 is a co-stimulatory factor present on B-cells, activated T-cells, and dendritic cells. CD70 overexpression may induce cytotoxic effects in B-cells and T-cells, induce lymphoc...

Background: Mature autogenous arteriovenous fistulas have better long term patency and require fewer secondary interventions compared to arteriovenous prosthetic graft. Our Study evaluated vascular patency rates and incidence of interventions in autogenous arteriovenous fistulas and grafts. Material and Methods: A total of 166 vascular access operations were performed in 153 patients between December 2002 and November 2009. Thirty seven caeses were excluded due to primary access failure and loss of follow-up. One group of 92 autogenous arterioveous fistulas and the other group of 37 arteriovenous prosthetic grafts were evaluated retrospectively. Primary and secondary patency rates were estimated using the Kaplan-Meier method. Results: The primary patency rate (84%, 67%, 51% vs. 51%, 22%, 9% at 1, 3, 5 year; p=0.0000) and secondary patency rate (96%, 88%, 68% vs. 88%, 65%, 16% at 1. 3, 5 year; p=0.0009) were better in autogenous fistula group than prosthetic graft group. Interventions to maintain secondary patency were required in 23% of the autogenous fistula group (average 0.06 procedures/patient/year) and 65% of prosthetic graft group (average 0.21 procedures/patient/year). So the autogenous fistula group had fewer intervention rate than prosthetic graft group (p=0.01) The risk factor of primary patency was diabetus combined with ischemic heart disease and the secondary patency’s risk factor was age. Conclusion: Autogenous arteriovenous fistulas showed better performance compared to prosthetic grafts in terms of primary & secondary patency and incidence of interventions.

Gastric perforation and tuberculous bronchoesophageal fistula (TBEF) are very rare complications of extrapulmonary tuberculosis (TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multidrug-resistant tuberculosis strain in a non-acquired immune deficiency syndrome male patient. The patient underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy and feeding jejunostomy during intravenous treatment with anti-TB medication, and esophageal reconstruction with colonic interposition and jejunocolostomy were performed successfully after a full course of anti-TB medication. Though recent therapies for TBEF have favored medication, patients with severe stenosis or perforation require surgery and medication with anti-TB drugs based upon adequate culture and drug susceptibility testing.

Background Venoveno bypass (VVB) has been used to achieve hemodynamic stability and decrease the incidence of renal dysfunction. However, VVB has many complications. The purpose of this study is to verify the safety of total clamping of the suprahepatic inferior vena cava (IVC) without VVB during orthotropic liver transplantation (OLT) in terms of anesthetic management. Methods Twenty-five patients without preoperative renal dysfunction who underwent primary OLT were enrolled in this study. Hemodynamic data and blood gas measurements were collected 1 hour after incision, 30 minutes after IVC total clamping and 30 minutes after reperfusion. Postoperative laboratory data, including blood urea nitrogen (BUN), creatinine (Cr) and glomerular filtration rate (GFR), were assessed at postoperative day (POD) 0-7, 30, 90, 180 and 1 year. Results Mean blood pressure was well maintained during IVC total clamping with infusion of inotropics. There was no case of severe acidosis (pH < 7.2) during the anhepatic period. The immediate postoperative Cr and GFR were not significantly different from those of the preoperative values. BUN increased from POD 1 and decreased after POD 6, while Cr increased at POD 90 only. Conclusions In patients without preoperative renal dysfunction, when IVC was totally clamped, VVB does not need to be routinely performed to maintain hemodynamics during the anhepatic phase and renal function after OLT.