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Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.

Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.

Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases in various malignancies.A retrospective analysis was performed to establish the safety and efficacy of cone-beam computed tomography (CBCT)-guided RFA in patients with metastatic colorectal cancer between 2016 and 2019, and the prognostic factors of local tumor control were assessed.A total of 31 patients with colorectal cancer underwent 48 sessions of lung RFA. The mean diameter of metastases targeted for RFA was 11 mm (range: 4-32), and the RFA was technically successful in 43 sessions (90%). There were 14 complications (29%), the majority of which required no intervention, with no cases of mortality. The median follow-up duration from RFA in the surviving 29 patients was 18.0 months. Only two patients (6%) died of disease progression, and the 3-year overall survival rate was 91% (95% CI: 83-99). Local tumor progression (LTP) of the RFA site was observed in 27%, and the LTP-free survival rates at 1 and 2 years were 81% (95% CI: 70-82) and 64% (95% CI: 50-77), respectively. Multivariate analysis showed that the progression of extra-RFA sites and the presence of extrapulmonary metastasis were independent prognostic factors significantly associated with LTP at RFA site.Lung RFA using CBCT guidance is a comparatively safe and effective option for the treatment of lung metastases from colorectal cancer. However, the control of extrapulmonary metastases should be accompanied by combined or sequential systemic treatment and local treatment.

Background Lung cancer and abdominal aortic aneurysm (AAA) have several common risk factors. Considering that AAA is fatal, precise diagnosis and management of AAA would result in long-term survival benefit in patients with early lung cancer with good prognosis. We aimed to assess the prevalence and characteristics of AAA in patients with resectable non-small cell lung cancer (NSCLC). Methods Between January 2019 and November 2020, 1,019 patients with primary NSCLC treated surgically in Severance and Kangbuk Samsung Hospitals were reviewed retrospectively. We re-read abdominal-pelvic computed tomography (APCT) and positron emission tomography (PET) images and evaluated the presence of AAA. The control group comprised 2,899 cancer-free people who had a health check-up CT scan in Severance between January 2018 and December 2019. The Institutional Review Board and Ethics Committee of Severance Hospital approved this study (IRB number: 4–2021–1430). Results Among patients with resectable primary NSCLC patients, 39/1,019 (3.8%; odds ratio [OR], 19.19; 95% confidence interval [CI], 8.10–46.46) had AAA compared with 6/2,899 (0.2%) in the control (P

Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to suggest a possible way to differentiate recurrence events based on temporal patterns. Methods: This single-center study retrospectively evaluated all postoperative recurrence of PSP from January 2007 to May 2019. Patients’ demographics, history of pneumothorax, radiologic data, surgical technique, and the time between operation and recurrence were analyzed. Univariate and multivariable analyses were conducted to find potential risk factors related to long-term recurrence. Results: Of the 77 postoperative recurrent cases of pneumothorax, 21 (27.2%) occurred within 30 days after surgery and, thus, were classified as early recurrences (ER), while the remaining cases were classified as late recurrences (LR). There was no difference in preoperative variables between the two groups. However, the rate of incidence of second recurrence (SR), which represented a long-term prognosis, was significantly higher in the LR group (28.6% vs. 4.8%, p = 0.030). On univariate and multivariable analyses, late recurrence was the only significant factor predicting later recurrence events. Conclusion: Postoperative recurrence (PoR) within 30 days had a lower SR rate. Therefore, it might not be a ‘true’ postoperative recurrence with a favorable prognosis. Further studies investigating postoperative recurrence based on temporal patterns would be warranted to improve the classification of PoR.

We aimed to investigate compensatory hyperhidrosis (CH) and recurrence based on an online survey of patients who underwent endoscopic thoracic sympathicotomy(ETS) for palmar and/or axillary hyperhidrosis.We enrolled 231 patients who underwent ETS for palmar and/or axillary hyperhidrosis from January 2008 to April 2021. Patients responded to an online questionnaire regarding CH and recurrence, their electronic medical records were reviewed. Logistic regression was performed to find the risk factors related to CH and recurrence.The median time of survey from surgery was 20 months. Although 94% of patients were satisfied with the surgery, 86.1% experienced CH; of them, it was severe in 30.7%. Three months after surgery, there was no long-term change in the severity of CH. The development of CH showed a close relationship with age of 20 years or more (OR: 2.73). Recurrence occurred in 44(19.0%) patients, and the use of anti-adhesive agents was a significant preventive factor against recurrence after ETS (OR: 0.42).We observed that CH and recurrence after ETS for palmar and/or axillary hyperhidrosis were relatively common. Age at the time of surgery was associated with CH, and the use of anti-adhesive agents showed to lower the risk of recurrence after ETS.

Objective To evaluate complications after consecutive 100 sessions of cone-beam computed tomography (CBCT)-guided radiofrequency ablation (RFA) of lung tumors Materials and methods A retrospective study was conducted from January 2016 and October 2018. All procedures were performed using a CBCT virtual navigation guidance system, combining three-dimentional CBCT, needle planning software, and real-time fluoroscopy. Complications were evaluated for each RFA session in 63 consecutive patients (31 male, 32 female; mean age 58.0 years) with 121 lung tumors who underwent 100 sessions of CBCT-guided lung ablation with an internally cooled RFA system. Complications were recorded using the Common Terminology Criteria of Adverse Events (CTCAE) 5.0. A major complication was defined as a grade 3 or 4 adverse event. Results There was no postprocedural mortality. The major and minor complication rates were 5% and 28%, respectively. The major complications were significant pulmonary hemorrhage (1%), large hemothorax requiring drainage (1%), pneumonia treated with antibiotics (2%), and delayed bronchopleural fistula (1%). The minor complications were pneumothorax (15%), hemoptysis (11%), and subcutaneous emphysema (2%). Of the 15 pneumothoraces, percutaneous catheter drainage was required in six sessions. Pneumothorax was more likely to occur if RFA was performed on two or more tumors at one session. Immediate, periprocedural and delayed complications were 23%, 9%, and 1%, respectively. Conclusion CBCT-guided RFA of lung tumors is a relatively safe procedure with acceptable morbidity.

There have been a few clinical studies on the use of three-dimensional (3D) laparoscopy with different results.To compare the surgical outcomes of 3D versus two-dimensional (2D) laparoscopic hysterectomy for benign or premalignant gynecologic diseases.In this double-blind trial, 68 patients were randomly assigned to either the 3D or 2D groups at a 1 : 1 ratio. The only difference between the two groups was the laparoscopic vision system used. The primary outcome was operative blood loss and operative time. The other surgical outcomes including failure of the intended surgery, length of hospital stay, and operative complications were also assessed.The baseline characteristics did not statistically significantly differ between the groups. The mean operative blood loss was not significantly different between the 3D group (74.4 ±51.6 ml) and the 2D group (79.2 ±55.4 ml) (p = 0.743). The operative time was similar in both groups (84.5 ±20.5 min vs. 87.8 ±24.4 min, p = 0.452). Moreover, no differences were observed between the groups in other surgical outcomes.The 3D imaging system had no surgical advantage in laparoscopic hysterectomy for benign or premalignant gynecologic diseases. However, 3D laparoscopy did not have any negative effects on surgical outcomes and did not increase the surgical risk.

Objective This study aimed to compare the surgical outcomes of three-dimensional (3D) and two-dimensional (2D) laparoscopic myomectomy. Study design. A total of 64 patients with symptomatic uterine fibroids were randomly assigned to either the 3D (n = 32) group or the 2D group (n = 32). The primary outcomes were the operative blood loss and change in hemoglobin levels. The secondary outcome was operative time. Results There were no differences in the baseline demographics between the two groups. The 3D and 2D groups were not significantly different in terms of operative blood loss (129.5 ± 86.5 mL vs. 140.9 ± 89.8 mL, P = 0.412), change in serum hemoglobin levels (1.4 ± 1.6 g/dL vs. 1.6 ± 1.6 g/dL, P = 0.553), and operative time (77.4 ± 37.8 min vs. 82.4 ± 35.4 min, P = 0.344). Furthermore, no differences were observed between the groups with regard to other surgical outcomes. Conclusion The 3D imaging system had no additional surgical benefit in laparoscopic myomectomy compared with to the conventional 2D imaging system.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is a commonly performed minimally invasive procedure that has led to lower levels of pain, as well as procedure-related mortality and morbidity. However, VATS requires analgesia that blocks both visceral and somatic nerve fibers for more effective pain control. This randomized controlled trial evaluated the effect of erector spinae plane block (ESPB) in the postoperative analgesia management of patients undergoing VATS. METHODS: We performed a prospective, randomized, single-center study between December 2018 and December 2019. Fifty-four patients were recruited to two equal groups (ESPB and control group). Following exclusion, 46 patients were included in the final analysis. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either ropivacaine or saline. The primary outcome was the numeric rating scale (NRS) score, assessed 12 hours postoperatively. Secondary outcomes were the Riker Sedation-Agitation Scale (SAS) score for emergence agitation, postoperative cumulative opioid consumption, length of post-anesthesia care unit (PACU) stay, incidence of postoperative nausea and vomiting (PONV) and dizziness, and ESPB-related adverse events. RESULTS: The NRS in the ESPB group during the postoperative period immediately after PACU admission was significantly lower than that in the control group (5.96±1.68 and 7.59±1.18, respectively; P

Background Endoscopic thoracic sympathectomy (ETS) has not been widely adopted for treating craniofacial hyperhidrosis (CFH) due to its known postoperative complication, compensatory hyperhidrosis (CH). In this study, we evaluated whether the autonomic nerve analysis data via pre-ETS heart rate variability (HRV) test can predict post-ETS CH in patients with CFH. Methods From October 2017 to March 2019, we consecutively included CFH patients who underwent ETS and received preoperative HRV. In this prospective observational study, we evaluated those who developed CH 3 months postoperatively. The CH grades were categorized into none, mild, moderate, and severe. Results A total of 53 patients were included; the mean age was 42.5±13.2 years, and there were 41 males (77.4%). Twenty-six (49.1%) patients had a post-ETS CH grade of greater than moderate (moderate and severe). We further classified the group into trivial and serious compensation, based on the CH grade for comparison. Among the various HRV values, low frequency/high frequency (LF/HF) value was the only one that achieved statistical significance (P=0.025). Moreover, among those in the trivial compensatory group, 23 (85.2%) patients had an LF/HF value between 0.66 and 2.60, and therefore, were included in the autonomic balanced group. On the other hand, among those in the serious compensatory group, 24 patients (92.3%) had an LF/HF value of less than 0.66 and greater than 2.60, and thus, in the autonomic dysfunction group. Conclusions According to the present study, HRV test, especially the HF/LF value, appears to be a useful test in predicting post-ETS serious CH.

Manifestations of malignant pleural effusions (MPEs) are alleviated by local therapies as well as by systemic treatment. After 2009, when commercial use of talc was discontinued in Korea, we have used Helixor-M, which is derived from the European mistletoe (Viscum album), as an alternative sclerosing agent for pleurodesis. We aimed to evaluate the efficacy and safety of Helixor-M for controlling MPE. Between 2009 and 2015, we consecutively enrolled 52 patients with lung cancer, who underwent pleurodesis to treat MPE and were analyzed retrospectively. On day 1, 100 mg of Helixor-M was instilled via pleural catheter. If the procedure was not effective, it was repeated every other day up to five times, and the dose increased each time by 100 mg. The primary study outcome was reappearance of pleural effusion at 1 month after the last pleurodesis procedure. The median age of patient was 63 years, and 77% of the 52 patients were male. About 85% of pleural effusions were found to be malignant by cytogenetic analysis. Forty-two (81%) patients were evaluable for recurrence of MPE. The 1-month recurrence rate was 48% (20/42). Among the 20 patients who developed recurrent MPE, 6 required therapeutic thoracentesis. Thirteen (25%) patients experienced procedure-related pain requiring medication. Eight (15%) had fever > 38 °C. Our results suggest that a pleurodesis with Helixor-M was an effective and tolerable procedure for controlling MPE in lung cancer patients.

Background: Endoscopic thoracic sympathectomy (ETS) has been considered as a definitive treatment for hyperhidrosis. However, despite its well-established success rate, surgical treatment for craniofacial hyperhidrosis (CFH) is rarely performed due to the possibility of fatal complications and compensatory sweating. The aim of this study was to evaluate the safety and efficacy of our newly developed method of ETS for CFH, based on early results. Methods: Between June 2016 and October 2017, a total of 70 patients underwent ETS with our new technique for CFH. All patients were placed under double-lumen intubation anesthesia with CO 2 gas installation. We utilized two ports, one for 2-mm endoscope and another for 3-mm instrument. Our technique involved R2 and R4–R7 sympathectomy with R4–R7 truncal ablation. Results: There were 55 males and 15 females, with a mean age of 48 years (range, 22–75 years). The median operation time was 38 minutes (range, 28–75 minutes). There was no operative mortality and morbidity. During the short follow-up period (average 7 months; range, 1–17 months), symptoms were improved in all patients and compensatory hyperhidrosis was observed 68 patients: mild in 50 patients (71.4%), moderate in 13 patients (18.6%), and severe in 5 patients (7.1%). Conclusions: In select patients, our technique of ETS appears to be a safe and effective treatment method for treating CFH. However, a study with long-term follow-up is still necessary to confirm our findings.

Prolonged air leak (PAL) is a major complication of pulmonary resection. Emphysema quantification with computed tomography is regarded as an important predictor of PAL for patients undergoing lobectomy. Therefore, we investigated whether this predictor might be applicable for segmentectomy. Herein, we characterized the factors that influence PAL in early stage lung cancer patients undergoing anatomical segmentectomy. Forty-one patients who underwent anatomical segmentectomy for early lung cancer between January 2014 and July 2017 were included for analysis. Several baseline and surgical variables were evaluated. In particular, the emphysema index (EI, %) and lobe-specific emphysema index (LEI, %) were assessed by using three-dimensional volumetric CT scan. PAL was observed in 13 patients (31.7%). There were statistically significant differences in DLCO (97.3% ± 18.3% vs. 111.7% ± 15.9%, p = 0.014), EI (4.61% ± 4.66% vs. 1.17% ± 1.76%, p = 0.023), and LEI (5.81% ± 5.78% vs. 0.76% ± 1.17%, p = 0.009) between patients with and without PAL. According to logistic regression analysis, both EI and LEI were significantly associated with PAL (p = 0.028 and p < 0.001, respectively). We found that EI and LEI significantly influenced the development of PAL after pulmonary resection. In particular, LEI showed stronger association with PAL, compared with EI, suggesting the importance of LEI in the prediction of PAL after anatomical segmentectomy.

Background: The purpose of this study was to determine whether electrical twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative to intravenous patient-controlled analgesia (IV-PCA) for postoperative pain management in pneumothorax patients undergoing single-port video-assisted thoracoscopic surgery (VATS). Methods: This preliminary prospective randomized study was conducted between March 2017 and July 2017. A total of 26 patients undergoing single-port VATS were randomly assigned to two groups: the ETOIMS group (n=12), which received intramuscular stimulation prior to chest tube insertion toward the end of procedure, and the IV-PCA group (n=14), which received continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. To measure postoperative pain, visual analogue scale (VAS; range, 0–10) was used as the primary endpoint. Results: Baseline characteristics were not different between the two groups. According to the linear mixed model, there was statistical difference in the serial VAS score between the two groups (P=0.007). The ETOIMS group showed a significantly lower VAS score compared with the IV-PCA group, especially at postoperatively hour 8, day 1, and day 2. Conclusions: We showed that ETOIMS may be a safe, effective, and simple alternative for pain management after single-port VATS.

Background: Hemorrhagic shock and resuscitation (HSR) is known to cause inflammatory reactions in the lung parenchyma and acute lung injury, increasing the risk of complications that can lead to death. Hydrogen gas has shown to inhibit the formation and eliminate reactive oxygen species (ROS), which are known to cause reperfusion injury. Hence, the purpose of this study was to investigate the protective effect of 2% inhaled hydrogen gas on post-HSR lung injury. Methods: Rats weighing 300–500 g were divided into three groups: sham, HSR, and hydrogen (H 2 )/HSR groups. In the latter two groups, HSR was induced via femoral vein cannulation. Gas containing 2% hydrogen gas was inhaled only by those in the H 2 /HSR group. Lung tissue and abdominal aorta blood were obtained for histologic examination and arterial blood gas analyses, respectively. Neutrophil infiltration and proinflammatory mediators were also measured. Results: PO 2 was lower in the HSR and H 2 /HSR groups than in the sham group. Blood lactate level was not significantly different between the sham and H 2 /HSR groups, but it was significantly higher in the HSR group. Infiltration of inflammatory cells into the lung tissues was more frequent in the HSR group. Myeloperoxidase (MPO) activity was significantly different among the three groups (highest in the HSR group). All proinflammatory mediators, except IL-6, showed a significant difference among the three groups (highest in the HSR group). Conclusions: Inhalation of 2% hydrogen gas after HSR minimized the extent of lung injury by decreasing MPO activity and reducing infiltration of inflammatory cells into lung tissue.

Although thoracoscopic surgery is commonly performed in patients with a pneumothorax and persistent air leak, it is still difficult to identify a definite air leak site during thoracoscopic surgery. The purpose of this study was to determine the safety, efficacy, and feasibility of intraoperative air leak site detection in spontaneous pneumothorax through low-pressure carbon dioxide (CO2) insufflation during thoracoscopic surgery. Of 54 patients who underwent thoracoscopic pneumothorax operations between March 2017 and March 2018, 22 pneumothorax patients underwent surgery for a persistent air leak. All patients were intubated with a single- or double-lumen endotracheal tube for general anesthesia. Three-port thoracoscopic surgery was performed, and CO2 was insufflated into the thoracic cavity at a pressure of 3–5 mmHg under two-lung ventilation to ensure visibility for video-assisted thoracoscopic surgery (VATS) and identification of the air leak site. Air leak sites were identified in all but one patient under CO2 insufflation. No intraoperative or postoperative adverse effects associated with CO2 insufflation were observed. The operative time was 37.8 ± 14.9 min (range 20–66 min), and the chest tube was removed after an average 2.7 ± 0.7 postoperative days (range 2–4 days). Patients were discharged after an average 4.1 ± 0.9 postoperative days (range 3–6 days). Postoperative recurrence was confirmed in 3 patients during 12.0 ± 4.0 months (range 5–16 months) of follow-up. A method to detect an air leak site during VATS for pneumothorax using low-pressure CO2 appears to be safe, effective, and feasible.

141 Background: Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases from several types of malignancies. Methods: A retrospective analysis was performed for the safety and efficacy of percutaneous RFA in patients with metastatic colorectal cancer between October 2016 and June 2019 as well as assessing prognostic factors of local tumor control. Results: RFA was carried out for 48 lung metastases in 31 consecutive colorectal cancer patients. Male was 17 patients (55%), and the median age at RFA was 61 years (range, 42-81). The mean diameter of metastases targeted for RFA was 12 mm (range, 4-32), and 17 tumors (35%) were located in a sub-pleural or deep position. Although five cases (10%) were failed due to immediate complications, there was no procedure-related death. In terms of immediate complication, a total of 12 cases (25%) had events including nine pneumothorax (percutaneous drain in four), one pleural effusion, and two hemoptysis (ICU care in one). Delayed complications were lung abscess and diaphragm injury in each one patient, respectively. At the time of analysis, the median follow-up duration from RFA was 12.0 months (interquartile range, 6.5-23.1). Only two patients (6%) died of disease progression, and 3-year overall survival rate was 85.5% (95% CI, 75.5-95.5). RFA site progression was observed in 11 patients (23%), and 1-year and 2-year progression-free survival rates were 71.5% (95% CI, 58.7-84.3) and 56.6% (95% CI, 42.6-70.6), respectively. Multivariate analysis showed that extra-pulmonary progression (hazard ratio 17.49; p = 0.023) was only one independent prognostic factor associated with RFA site progression after adjusting for confounding factors including sex, age, performance, tumor size, location, contact with the vessel, last chemotherapy response, and duration. Conclusions: RFA is a comparatively safe and effective option for the treatment of small-sized lung metastases; however, the control of extra-pulmonary metastases should be accompanied for effective local control.

Infections caused by Gemella morbillorum are uncommon. This organism is primarily associated with endocarditis and bacteremia and rarely with spondylodiscitis, arthritis, hepatic abscesses and meningitis. Sternal osteomyelitis caused by G. morbillorum has not yet been reported. We herein present a case of sternal osteomyelitis with a mediastinal abscess caused by G. morbillorum that occurred in a 74-year-old diabetic patient following blunt force trauma to the anterior chest wall. The patient was treated successfully with surgical excision and prolonged antibiotic treatment. Early recognition and timely intervention are important for managing life-threatening osteomyelitis of the sternum.

Background This study evaluated the relationship between 18F-fluorodeoxyglucose (FDG) uptake in bone marrow (BM) on positron emission tomography (PET)/computed tomography (CT) imaging and serum inflammatory markers and assessed the prognostic value of FDG uptake of BM in patients with non–small-cell lung cancer (NSCLC) who underwent curative surgical resection. Patients and Methods We retrospectively enrolled 110 NSCLC patients who underwent FDG PET/CT imaging and subsequent curative surgical resection. The maximum standardized uptake value of NSCLC (Tmax), mean FDG uptake of BM (BM SUV), and BM to liver uptake ratio (BLR) were measured. The relationships between BM SUV, BLR, and serum inflammatory markers were evaluated and the prognostic significance of PET/CT parameters for predicting recurrence-free survival (RFS) and overall survival (OS) were assessed. Results BM SUV and BLR were significantly associated with serum C-reactive protein (CRP) level, white blood cell count, and the neutrophil to lymphocyte ratio (NLR). BLR was also significantly correlated with serum albumin and the platelet to lymphocyte ratio. In univariate analysis, tumor, node, metastases (TNM) stage, serum CRP level, NLR, Tmax, and BLR were significant prognostic factors for RFS and OS, whereas histopathology and tumor size were significant prognostic factors for RFS. In multivariate analysis, BLR, histopathology, TNM stage, and Tmax were independent prognostic factors for RFS and TNM stage and Tmax were independent prognostic factors for OS. Conclusion FDG uptake of BM on PET/CT imaging was correlated with serum inflammatory markers and was an independent predictor for RFS, along with FDG uptake of NSCLC.

Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominant disease presenting with skin fibrofolliculomas, pulmonary cysts, primary spontaneous pneumothorax (PSP), and renal cancer. It is caused by germline mutations in the FLCN gene, which encodes folliculin. Here we report a novel in-frame deletion mutation p.F143del (c.427_429delTTC) in exon 6 of FLCN gene in the proband and her two sisters. The proband was a 40-year-old Korean woman who presented with right-sided pneumothorax and papular lesions on the face and neck area but without renal cancer. Her father also had a history of PSP and died of renal cancer at the age of 75. Her older sisters have been treated for recurrent PSP but did not have skin lesions suspicious of fibrofolliculoma. The relative expression of FLCN was significantly reduced in the proband and one of the sibling who was confirmed to have FLCN mutation. In-frame deletions in the FLCN gene have rarely been reported but have been shown to impose significant effect on protein stability of FLCN. Identification of a novel genotype in BHDS will provide clues to the phenotype-genotype relations and may aid in explaining the molecular pathogenesis of diseases related to FLCN mutation.

Primary salivary gland-type lung cancer is rare, and little is known about the role of surgery. The aim of this study was to analyze surgical role and outcome for primary salivary gland-type lung cancer. Between October 1995 and June 2008, 48 patients underwent surgical treatment for primary salivary gland-type lung cancer. Medical records were analyzed for age, sex, tumor histopathology, location, surgical resection, tumor grade, clinical outcome, and survival. There were 31 male and 17 female patients, with an average age of 41.1 ± 15.2 years. Mucoepidermoid carcinoma was diagnosed in 26 patients, adenoid cystic carcinoma was diagnosed in 20 patients, and epithelial–myoepithelial carcinoma was diagnosed in 2 patients. The operative procedure included (bi) lobectomy (n = 15, 31.2%), sleeve lobectomy (n = 13, 27.1%), tracheal resection (n = 8, 16.7%), pneumonectomy (n = 7, 14.6%), and carinal resection (n = 5, 10.4%). There was no operative mortality, and minor morbidity occurred in eight patients. Incomplete resection occurred in eight patients, and six of them received postoperative radiotherapy. Of incompletely resected patients, cancer recurrence was found in three patients, and all were in the adjuvant radiotherapy group. Overall, cancer recurred in 11 patients (22.9%), and 4 of them were treated by repeated surgical resection and were alive and disease-free at the conclusion of this study. The overall 5-year and 10-year survival rates after operation were 97.6 and 86.7%. Surgical resection of primary salivary gland-type lung cancer was an effective treatment with low operative morbidity, and expected long-term survival. Repeated surgical resection may be considered an effective treatment modality in some cases of recurrence.

In the previous report, to simplify the synthesis and labelling procedures and to improve the biological properties, we developed a novel mannose receptor-binding agent, technetium-99m human serum albumin (99mTc-MSA), for sentinel lymph node detection. This study is the first clinical trial designed to test the reliability and feasibility of sentinel node detection using this new radioactive agent in patients with stage I non-small cell lung cancer.Forty-two patients (30 men, 12 women; mean age 63.3 + or - 8.9 years) that were candidates for lobectomy with mediastinal lymph node dissection for stage I non-small cell lung cancer were enrolled. A total dose of 1mCi of 99mTc-MSA in 0.2 ml was administered in one shot at the peritumoural region approximately 3h before surgery. The radioactivity in the lymph nodes was counted before (in vivo) and after (ex vivo) dissection with a hand-held gamma probe. A sentinel lymph node was defined as any node for which the radioactivity count was 5 times that of the resected lung tissue with the lowest count for the ex vivo counts. All harvested lymph nodes were cut into 2-mm slices and ultimately diagnosed by using formalin-fixed and paraffin-embedded sections with haematoxylin and eosin staining.99mTc-MSA was taken up by the lymph nodes and its detection did not change until 21 h after the injection. The number of dissected lymph nodes per patient was 22.1 + or - 11.6 (range 4-57). Among 42 patients, the sentinel lymph nodes could be identified in 40 patients (95.2%). The number of sentinel lymph nodes identified was 2.3 + or - 1.1 stations (range 1-5) per patient. Ten out of 40 patients (25.0%) had metastases in 11 sentinel lymph nodes. Three of these 11 sentinel lymph nodes (27.3%) had skip metastases. No false-negative sentinel lymph nodes were detected in any of the 10 patients with N1 or N2 disease (0%). The relationship between in vivo and ex vivo results for mediastinal sentinel lymph nodes showed concurrence in 29 out of 40 patients (72.5%).Intra-operative sentinel lymph node identification using 99mTc-MSA appears to be feasible and reliable in stage I non-small cell lung cancer.

We investigated the effects of charge trapping on the asymmetrical increase of the memory window in metal-ferroelectric-insulator-semiconductor (MFIS) devices. We suggest that defect centers located at the SBN-Y 2 O 3 interface play important roles for generating the asymmetrical increase of the memory window: For example, electron trapping at the SBN-Y 2 O 3 interface via Fowler-Nordheim tunneling (FNT) injection from the Si substrate results in the preferential domain switching, causing the asymmetrical increase of the memory window. We also suggest that FNT injection in the Pt/SBN/Si MIS capacitors causes the symmetrical increase of the memory window because the SBN-Y 2 O 3 interface does not exist. However, charge trapping in the SBN layer reduces the memory window with time after FNT injection had stopped, while no significant degradation of the memory window was observed in the Pt/SBN-Y 2 O 3 /Si capacitors.

OBJECTIVES: The aim of this study was to identify factors affecting patient compliance with brace therapy for pectus carinatum. METHODS: Eighty-six pectus carinatum patients who started brace therapy from August 2008 to November 2011 were included in this study. Patients were divided into two groups: patients who wore the brace for ≥6 months (compliance group) or patients who wore the brace for

BACKGROUND The aim of this study was to investigate the association between the presence of lymphatic vessel invasion (LVI) in primary tumors and lymph node (LN) metastasis in clinical stage I non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS A total of 76 patients who underwent complete resection for clinical stage I adenocarcinoma and squamous cell carcinoma were retrospectively examined. RESULTS Tumors consisted of 51 cases of adenocarcinoma and 25 cases of squamous cell carcinoma as determined by histology. LN metastasis was detected in 24.4% (19/76) of patients. Factors associated with LN metastasis on univariate analysis included LVI (p

Foreign body ingestion is a commonly encountered clinical problem in pediatric emergency cases. The authors report a case of an esophageal foreign body caused by the accidental ingestion of a shell in an 8-month-old girl. Endoscopic removal was attempted but failed because of the sharp margin of the shell and caused it to be deeply impacted into the esophageal wall. Accordingly, a pneumatic lithotriptor was inserted through a rigid esophagoscope and used to fragment the shell.

Infections caused by Gemella morbillorum are uncommon. This organism is primarily associated with endocarditis and bacteremia and rarely with spondylodiscitis, arthritis, hepatic abscesses and meningitis. Sternal osteomyelitis caused by G. morbillorum has not yet been reported. We herein present a case of sternal osteomyelitis with a mediastinal abscess caused by G. morbillorum that occurred in a 74-year-old diabetic patient following blunt force trauma to the anterior chest wall. The patient was treated successfully with surgical excision and prolonged antibiotic treatment. Early recognition and timely intervention are important for managing life-threatening osteomyelitis of the sternum.

This prospective study was conducted to evaluate the feasibility of two-lung (TL) ventilation with low tidal volume anaesthesia compared with one-lung (OL) ventilation for needlescopic bleb resection. Patients with spontaneous pneumothorax that underwent bleb resection with a 2-mm thoracoscope were enrolled. During the operation, the tidal volume was set at 4.0 mL·kg⁻¹ in the TL group and 8.0 mL·kg⁻¹ in the OL group; the respiration rate was set at 23 and 12 breaths·min⁻¹, respectively, at the same inspiratory oxygen fraction (50%). A total of 108 patients (55 patients in the TL group and 53 in the OL group) were included in this study. Airway pressure was significantly lower in the TL group (mean ± sd 8.0 ± 3.3 versus 24.0 ± 3.9 mmHg in the OL group; p

The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule. Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy. The mean age of the patients was 58 ± 12 (range 12-77) yrs. The mean size of the nodules was 7.5 ± 3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3 ± 7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1 ± 4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection. Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.

We report a case of a nonunited sixth rib in a patient with multiple rib fractures who underwent internal fixation using a wire and Judet strut 3 times. During the following 3 years, the patient continued to complain of pain and instability. At surgery, a pseudarthrosis between the ends of the sixth rib was excised. A longitudinal gutter crossing the fracture site was fashioned and splinted with an inlay block of cancellous bone grafted from the iliac crest; stabilization was accomplished with a reconstruction plate and screws. The following 2 years of follow-up demonstrated no instability or pain.