Fumihiro Ogawa

Traumatic hemothorax commonly occurs accompanied by organ damage, such as rib fractures, lung injury and diaphragm rupture. Our reported patient was a 61-year-old man who fell down from a stepladder about 1 meter in height, resulting in a heavy blow to the left abdomen. He consulted a clinic because of left chest pain the next day and was transported to the emergency center of our hospital on diagnosis of hemothorax with hemorrhagic shock.

While surgery for elderly patients has become more common with the aging of populations, the relatively high frequency of postoperative complications prevents broad application. We retrospectively evaluated prognoses after surgery for non-small-cell lung cancer in patients older and younger than 75 years, to investigate whether age contributes to the risk of a poor outcome. From January 1998 to September 2009, 727 patients underwent curative resection for non-small-cell lung cancer in our department; 119 were over 75-years old (group 1) and 608 (group 2) were aged less than 75 years. The rates of postoperative complications (49% in group 1 and 40% in group 2) were not significantly different. Age conferred no significant risk, with an odds ratio of 1.129, whereas smoking, blood loss during surgery, and lymph node dissection exhibited significant associations. Those aged over 75 years had a 1.9-fold higher risk of mortality (p < 0.01), but significance did not extend to disease-specific survival (p = 0.117). Postoperative complications in elderly non-small-cell lung cancer patients are dependent on factors such as smoking, blood loss during surgery, and lymph node dissection, but not age. Elderly patients should not be considered ineligible for surgical treatment due to their age alone.

Because the cavopulmonary shunt procedure is widely used for palliation of complex congenital heart diseases, pulmonary arteriovenous malformations (PAVMs) are relatively well-known complications. The reported patient was a 23-year-old woman who experienced PAVMs in the right lower lobe after a classical Glenn anastomosis and Björk procedure for tricuspid atresia. Her arterial oxygen saturation (SaO₂) 14 years after the Björk procedure was ~80 %. She then underwent a total cavopulmonary connection (TCPC) conversion to reduce her PAVMs in the right lower lobe using the “hepatic factor.” However, her situation remained unchanged, and she experienced severe systemic cyanosis (SaO₂, 70 %) and dyspnea during physical exertion without hemoptysis due to increased blood flow to the PAVMs. Although interventional embolization was considered, it was impossible due to considerable dilation of the main PAVM. Thus, right lower lung lobectomy was performed. After surgery, the patient’s SaO₂ increased to 90 %. To the authors’ knowledge, this is the first case report of a lung resection for residual PAVMs after TCPC conversion.

Thymic large cell neuroendocrine carcinomas (LCNECs) are very rare. We here describe a case in which the tumor could be completely resected. A 55-year-old male was admitted to our hospital for treatment of an anterior mediastinal tumor found at a regular health check-up. The patient underwent an extended thymectomy of an invasive thymoma of Masaoka's stage II that had been suspected preoperatively. The tumor was located in the right lobe of the thymus and was completely resected. Final pathological diagnosis of the surgical specimen was thymic LCNEC. The patient underwent adjuvant chemotherapy with irinotecan and cisplatin in accordance with the diagnosis of a lung LCNEC, and is alive without recurrence or metastasis 16 months after surgery.