Main right hepatic duct entering the cystic duct: a case report.

Background: Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the various biliary anomalies and early identification may therefore assist in decreasing the rate of bile duct injury.

Case Presentation: A 65-year-old woman was admitted with right hypochondrial pain and high fever.

Early and Mid-Term Outcomes Following TEVAR for Chronic Type B Aortic Dissection.

We examined the outcomes of aortic remodeling for chronic type B aortic dissection (cTBD) after thoracic endovascular aneurysm repair (TEVAR). : Thirty-eight patients underwent TEVAR for cTBD at our institution. We classified cTBD patients into the early cTBD group (16 cases, 2 weeks-4 months from onset) and late cTBD group (22 cases, >4 months from onset).

Chimney technique for aortic dissection involving an aberrant right subclavian artery.

We report a case involving a ruptured acute type B aortic dissection originating from an aberrant right subclavian artery (ARSA). A thoracic stent-graft was deployed in the distal arch close to the origin of the ARSA; the entry site at the origin of the ARSA was embolized with metallic coils. Perfusion of the left subclavian artery was preserved without a surgical bypass by using a chimney graft.

Endovascular repair of distal arch aneurysm with double-chimney technique.

We report 2 cases of distal arch aneurysm treated by thoracic endovascular aneurysm repair (TEVAR) with the "double-chimney technique." This technique permitted the implantation of a thoracic stent graft in the ascending aorta over the arch branches while preserving perfusion of innominate and left common carotid arteries without debranching bypasses. The procedure is a feasible and less invasive treatment for distal arch aneurysm with a short proximal neck (<2 cm to the origin of the innominate artery) in patients at high risk when undergoing sternotomy and in emergent cases.

Single-stage thoracic and abdominal endovascular aneurysm repair for multilevel aortic disease.

This investigation evaluated the results of single-stage thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR) for multilevel aortic disease in a series of nine patients. The lesions repaired included thoracic and abdominal aortic aneurysms (n= 7) and subacute type B dissections with abdominal aortic aneurysms (n=2). All procedures were successfully performed, and none of the patients experienced postoperative stroke or spinal cord ischemia.

[A recurrent case of lipid-secreting carcinoma of the breast successfully treated with capecitabine].

We herein report a recurrent case of lipid-secreting carcinoma of the breast which was successfully treated with capecitabine. A 50-year-old female underwent a pectoralis-preserving mastectomy for left breast cancer in December 2002. The clinical staging of the disease was T2N1M0 (stage II B) and ER (-), PgR(-), HER2 (1+).

Prediction of hypoxemia after lung resection surgery.

Pulmonary resection under general anesthesia induces various degrees of hypoxemia that adversely impacts on postoperative recovery. Consecutive of 53 patients undergoing anatomical pulmonary resection were enrolled in this study to accurately define predictors of postoperative hypoxemia. Preoperative variables studied included spirometric variables, blood gases, and extent of low attenuation area (below -910 Hounsfield units) on a three-dimensional computed tomography lung model.

Breath-hold single-photon emission tomography and computed tomography for predicting residual pulmonary function in patients with lung cancer.

Objective: We sought to evaluate the utility of integrated breath-hold single-photon emission tomography and computed tomography imaging compared with that of simple calculation with the lung segment-counting technique for predicting residual pulmonary function in patients undergoing surgical intervention for lung cancer.

Methods: A prospective series of 22 patients undergoing anatomic lung resection for cancer were enrolled in this study. Postoperative residual forced expiratory volume in 1 second was predicted by measuring the radioactivity counts of the affected lobes or segments to be resected within the entire lungs by placement of regions of interest on single-photon emission tomography and computed tomography images.

Relationship among Genetic Alterations, DNA Content, and Clinicopathological Features in Primary Lung Adenocarcinomas.

Background: Only fragmentary information is available about the genomic imbalances affecting the malignant potential of lung cancers.

Patients And Methods: Chromosomal DNA sequence copy number aberrations (DSCNAs) and DNA content (ploidy status) were examined in 34 resected tumor specimens, using comparative genomic hybridization and laser scanning cytometry, respectively.

Results: Twenty-seven tumors showed DNA aneuploidy.

Successful treatment of intracardiac progression and metachronous multiple brain metastases from primary lung cancer.

We report a rare case of squamous cell carcinoma of the lung extending into the left atrium via the pulmonary vein. The tumor tissue including the thrombus was resected en-bloc under cardiopulmonary bypass. Despite adjuvant chemotherapy, multiple brain metastases developed, but they were eradicated by stereotactic radiosurgery.

Cerebral air embolism during imaging of a sentinel lymphatic drainage in the respiratory tract.

We report a rare but notable case of cerebral air embolism complicating transthoracic intrapulmonary injection of an imaging agent used to locate sentinel lymph nodes. After a bolus injection of 2 mL of iopamidol into the peritumoral area with a 23-gauge needle, the patient complained of complete paralysis on his left side. Intraaortic gas was detected by computed tomography immediately after the injection.

Role of quantitative CT in predicting hypoxemia and complications after lung lobectomy for cancer, with special reference to area of emphysema.

Study Objectives: To determine the ability of quantitative CT, with special reference to area of emphysema, to predict early postoperative oxygenation capacity and outcome after lung lobectomy for cancer.

Methods: Sixty-two consecutive patients scheduled to undergo lung lobectomy for cancer were enrolled in this study. The area of emphysema (< - 910 Hounsfield units) was measured on a three-dimensional CT lung model.

Genomic alterations detected by comparative genomic hybridization in primary lung adenocarcinomas with special reference to the relationship with DNA ploidy.

To clarify the clinicopathological and biological significance of genomic alterations in pulmonary adenocarcinomas, we examined chromosomal DNA sequence copy number aberrations (DSCNAs) and DNA ploidy in 42 surgically resected specimens by comparative genomic hybridization (CGH) and laser scanning cytometry (LSC), respectively. The number of DSCNA did not affect the size of carcinoma or number of nodal metastasis. More than 60% of carcinomas showed a 1q21-23 gain or 13q21 loss.

Quantitative computed tomography versus spirometry in predicting air leak duration after major lung resection for cancer.

Background: Emphysema is a well-known risk factor for developing air leak or persistent air leak after pulmonary resection. Although quantitative computed tomography (CT) and spirometry are used to diagnose emphysema, it remains controversial whether these tests are predictive of the duration of postoperative air leak.

Methods: Sixty-two consecutive patients who were scheduled to undergo major lung resection for cancer were enrolled in this prospective study to define the best predictor of postoperative air leak duration.

Video-assisted transcatheter lung perfusion regional chemotherapy.

Objective: To establish a technique for performing isolated lung perfusion (ILP) under video-assisted thoracic surgery (VATS) to treat unresectable lung malignancies.

Methods: Under fluoroscopic and thoracoscopic guidance, five canine left lungs were isolated by means of an endovascular technique comprising pulmonary artery cannulation through the right femoral vein and pulmonary vein cannulation through the left auricular appendage (VATS-ILP). ILP was performed for 20 min at a flow rate of 30 ml/min with a high-dose cisplatin solution (50 microg/ml).

Computed tomography lymphography with intrapulmonary injection of iopamidol for sentinel lymph node localization.

Purpose: Experimental and clinical evaluation of the potential utility of indirect computed tomographic lymphography (CT-LG) with intrapulmonary injection of iopamidol for preoperative localization of sentinel lymph node station in non-small cell lung cancer.

Methods: CT-LG with intrapulmonary injection of 0.5 mL of undiluted iopamidol was performed in 10 dogs using a multidetector-row CT unit, followed by postmortem examination of enhanced lymph nodes in 5 of these dogs.

Preoperative imaging of the lung sentinel lymphatic basin with computed tomographic lymphography: a preliminary study.

Background: Preoperative localization of the sentinel node basin would guide selective lymph node dissection. We tried to identify these nodal stations with indirect computed tomographic lymphography using a conventional extracellular contrast agent, iopamidol.

Methods: Eleven consecutive patients scheduled to undergo anatomic resection of suspected lung cancer, without lymphadenopathy, were given a peritumoral injection of undiluted iopamidol under computed tomography guidance, and lymphatic migration was assessed by multidetector-row helical computed tomography.

Radioisotope lymph node mapping in nonsmall cell lung cancer: can it be applicable for sentinel node biopsy?

Background: Previous studies on intrathoracic lymph node mapping have focused on the validity of a sentinel node concept, but not on the usefulness for sentinel node biopsy.

Methods: The subjects were 15 patients clinically diagnosed with N0 nonsmall cell lung cancer. Technetium-99m tin colloid was injected into the peritumoral area 1 day preoperatively and a time course of tracer migration was monitored by scintigraphy.

Obstacles for shortening hospitalization after video-assisted pulmonary resection for lung cancer.

Background: Video-assisted thoracic surgery for lung cancer facilitates early postoperative recovery when patients are treated by critical pathway management. Thus, we developed an original programmed regimen for postoperative management, evaluated the validity of this regimen, and analyzed clinical factors influencing postoperative recovery.

Methods: Forty consecutive patients with suspicious lung cancer undergoing anatomic pulmonary resection with video-assisted thoracic surgery were enrolled in this prospective study.

Effect of radioisotope sentinel node mapping in patients with cT1 N0 M0 lung cancer.

Background: Application of the sentinel node concept to lung cancer is still controversial. Patients with peripheral small lung cancers would gain the most benefit from this concept, if it were valid. We sought to determine whether it is possible to choose between limited lymph node sampling and systematic lymphadenectomy from the distribution of sentinel lymph nodes in patients with node-negative disease on the basis of imaging.

Independent predictive value of the overall number of metastatic N1 and N2 stations in lung cancer.

Objective: The number of metastatic N2 stations is a known prognostic factor in patients with non-small-cell lung cancer (NSCLC). However, involvement of N1 stations as well as that of N2 stations seems to be important in the prognosis of these patients. We therefore attempt to clarify the significance of the total number of metastatic stations in pathologic N1 and N2 NSCLCs.

Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions.

Study Objectives: A new marking technique was developed to localize small or indistinct pulmonary lesions, involving preoperative radioisotope injection and intraoperative detection with a handheld gamma probe.

Setting: National hospital for respiratory disease.

Methods: and patients: A technetium suspension (either (99m)Tc tin colloid [2 to 4 mCi, 0.

Comparison of three tracers for detecting sentinel lymph nodes in patients with clinical N0 lung cancer.

The goal of this pilot study was to compare three tracers for the detection of sentinel nodes in patients with lung cancer. Forty-eight patients with clinical N0 non-small cell lung cancer were enrolled. Indocyanine green (n=16) or isosulfan blue (n=18) was injected around the tumor intraoperatively, or technetium tin colloid was injected preoperatively under CT guidance (n=14).

Hilar lymph nodes in N2 disease: survival analysis of patients with non-small cell lung cancers and regional lymph node metastasis.

Purpose: This study was conducted to accurately define the N status of non-small cell lung carcinoma (NSCLC).

Methods: We retrospectively reviewed 147 patients with NSCLC and pathologically positive regional lymph nodes who underwent major pulmonary resections with complete mediastinal lymph node dissections.

Results: The overall 5-year survival rate was 41% after a median follow-up period of 33 months.