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The natural history of osteonecrosis of the femoral head is generally thought to be one of progressive deterioration if no intervention is undertaken. However, it is unknown whether surgical intervention is beneficial for patients with a small region of osteonecrosis. We observed rapid improvement of MRI findings after rotational acetabular osteotomy (RAO) was performed in a young patient with osteonecrosis of the femoral head. The band-like low signal area on T2-weighted images almost resolved by six months after surgery. He returned to work as an electrician by six months after surgery. Early surgical intervention such as RAO that alters the mechanical force acting on the necrotic region of the femoral head may accelerate the recovery of osteonecrosis and the improvement of symptoms. [ABSTRACT FROM AUTHOR]

A right aortic arch is a rare congenital anomaly, with a reported incidence of around 0.1%. A patient with a right aortic arch underwent video-assisted thoracic surgery left lower lobectomy and mediastinal lymph node dissection for squamous cell carcinoma. There was no aortic arch or descending aorta in the left thoracic cavity, but the esophagus. There was no anomaly in the location or branching of the pulmonary vessels, the bronchi, and the lobulation of the lungs. The vagus nerve was found at the level of the left pulmonary artery. The arterial ligament was found between the left subclavian artery and the left pulmonary artery. The recurrent laryngeal nerve was recurrent around the left subclavian artery. A Kommerell diverticulum was found at the origin of the left subclavian artery. The patient experienced no complications. We conclude that video-assisted thoracoscopic lobectomy with mediastinal dissection is feasible for treating lung cancer with a right aortic arch. [ABSTRACT FROM AUTHOR]

A 58‒year‒post‒menoposal woman was presented with left chest pain and shortness of breath because her breast cancer metastasized to the skin, lung, and pleural dissemination. In late‒line treatment for hormone receptor‒positive HER2‒negative advanced/recurrent breast cancer, we experienced a patient with tumor shrinkage leading to pain relief who was treated with a second combination of a CDK4/6 inhibitor and fulvestrant. Due to her poor performance status, she was treated with combined therapy to avoid severe adverse events. The CDK4/6 inhibitor was reintroduced after 1.5 years withdrawal period of endocrine therapy during anticancer drugs and radiation treatment. It has also been reported that withdrawal of CDK4/6 inhibitors might restore susceptibility related to the inhibitory signal. Rather than sequentially administering combined endocrine therapy with a CDK4/6 inhibitor, the withdrawal strategy of endocrine therapy continuing to administer anticancer drugs should be considered in case of reintroduction of CDK4/6 inhibitor.

Background: According to the aging in Japan, surgery of lung cancer with cardiovascular disease is increasing. Among them, the merger of the heart and large blood vessel disease would be expected to be directly linked to the perioperative management., Materials and Methods: We conducted a retrospective analysis of 1,005 patients who had undergone surgical resection of primary lung adenocarcinoma between January 1997 and June 2014 at Hokkaido University Hospital. Among them, 81 patients had more than one cardiovascular disease., Results: The median age was 71 years old. Men are 62 cases(76%). 64 cases (79%)had smoking history. Ischemic heart disease( IHD) was 29 cases(33%), followed by atrial fibrillation(Af), arrhythmia other than Af, valve disease and macrovascular disease. Anticoagulant or antiplatelet therapy were preoperatively done in 41% of IHD cases, 39% of Af cases. Thirty four% of IHD, 50% of vascular disease received the treatment other than medication. Video-assisted thoracic surgery was performed in 67 cases(83%). Lobectomy, sublobectomy were performed for 59 cases(73%), 19 cases(23%), respectively. Postoperative complications were occurred in 32 cases(40%). Two patients(2.5%)died in hospital without discharge. Univariate analysis revealed tumor size, pStage, lymph node dissection, operation time or blood loss were correlated with postoperative complication., Conclusions: For the patients with cardiovascular disease, careful evaluation of surgical indication, perioperative management is required.

Aim: Surgical resection is a standard therapeutic approach for some cases of non-small cell lung cancer (NSCLC). Fluorodeoxyglucose positron-emission tomography (FDG-PET) is now widely used in clinical diagnosis and staging of various types of cancers, including NSCLC. We investigated whether the maximum standardized uptake value (SUVmax) of primary tumors is useful in predicting the extent of lymph node involvement., Patients and Methods: We retrospectively evaluated 354 patients with NSCLC who underwent surgery following FDG-PET and computed tomographic (CT) scans in our hospital. Logistic regression analyses were used to assess associations between categories (age, sex, tumor size, SUVmax, serum Squamous cell carcinoma-related antigen (SCC), cytokeratin 19 fragment (CYFRA), carcinoembryonic antigen (CEA), Brinkman index and histologic type. Differences in SUVmax of primary tumors between positive and negative lymph node involvement were examined by Mann-Whitney U-test., Results: SUVmax of primary tumors in patients without lymph node involvement was significantly lower than in those with involvement, in both adenocarcinoma and squamous cell carcinomas (median, 2.2 vs. 4.9 in adenocarcinoma and 5.0 vs. 8.1 in squamous cell carcinoma, p<0.001 for both). Among node-positive cases, the lowest primary tumor SUVmax was 1.24 in an adenocarcinoma and 2.05 in a squamous cell carcinoma. However, primary tumor SUVmax and extent of lymph node metastases showed no significant differences between pN1 and pN2, single and multiple lymph node involvement, or single and multiple station involvement., Conclusion: A low primary tumor SUVmax in NSCLC may help identify patients with no lymph node involvement. However, SUVmax does not discriminate between minimal and extended lymph node involvement.

Background: This study aimed to evaluate the necessity for the partial volume effect (PVE) correction of the maximum standardized uptake value (SUVmax) in (18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET) for predicting outcome in patients with non-small cell lung cancer (NSCLC)., Patients and Methods: A total of 191 patients, with tumor diameters ranging from 10-37 mm, underwent pre-operative FDG-PET and curative resection. The SUVmax (Pre-SUV) of the primary tumor was corrected (Cor-SUV) using a recovery coefficient curve based on phantom experiments., Results: The 5-year overall survival (OS) and disease-free survival (DFS) of the patients with high Pre-SUVs were lower than those with low Pre-SUVs (p<0.001 and p=0.002, respectively). The 5-year OS and DFS of patients with high Cor-SUVs were significantly lower than those with low Cor-SUVs (p<0.001 and p=0.005, respectively)., Conclusion: Even without PVE correction, SUVmax was able to predict for outcome in patients with NSCLC.

Background: Most of mediastinal tumors are benign cysts and neoplasms. Resection is indicated for cystic lesions because of possibility of malignancy, compression symptom and possible rupture in future. However careful observation might be appropriate for asymptomatic tumors without risk of malignancy. Although video-assisted thoracoscopic surgery (VATS) is increasingly performed, its indication is still controversial., Patients and Results: Among 37 mediastinal cystic lesions with confirmed pathological diagnosis, 17 were neoplasms. All of 20 non-neoplastic lesions have cyst wall thinner than 5 mm. Five cases( 29%) of neoplastic lesions have cyst wall thinner than 5 mm. Three of them underwent preoperative fluorodeoxyglucose-positron emission tomography( FDG-PET) or PET-computed tomography( CT). All 3 neoplastic lesions with thin wall showed accumulation of FDG. None of non-neoplastic cyst had FDG accumulation. Ninety-seven patients underwent surgical resection for mediastinal tumors. Out of 51 VATS, 2 were converted to open thoracotomy. One patient with thymoma had ipsilateral pleural recurrence after VATS. Tumor sizes of those 3 patients were larger than 7 cm., Conclusions: Cystic mediastinal tumor with wall thickness less than 5 mm and no FDG accumulation might be observed without resection because it is very unlikely to be a neoplasm. Mediastinal tumor larger than 7 cm might not be suitable for VATS.