Tuesday, March 22, 2011

Hypertension in Japan


Am J Hypertens. 2011 Mar 17. [Epub ahead of print]
Contributions of Social Context to Blood Pressure: Findings From a Multilevel Analysis of Social Capital and Systolic Blood Pressure.
Hamano T, Fujisawa Y, Yamasaki M, Ito K, Nabika T, Shiwaku K.

1] Organization for the Promotion of Project Research, Shimane University, Matsue, Japan [2] Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan.
BackgroundIn recent years, few studies have quantified the effect of residential context on blood pressure. Although these studies have emphasized the importance of socioeconomic influences such as education or poverty levels, the association between the features of social structure such as social capital and blood pressure remain unclear. Therefore, we investigated whether social capital was associated with systolic blood pressure after controlling for individual potential confounders.MethodsWe analyzed data from the Shimane Study conducted from 2006 to 2008 in rural mountainous regions of Japan. After excluding the missing data and data of participants taking hypertension medication, we conducted a multilevel analysis of the data for 335 individuals nested within 30 postcode sectors.ResultsSystolic blood pressure increased with increasing age and body mass index. We also found that a higher systolic blood pressure was observed among smokers and those taking medication for diabetes. Regarding the contextual effects of social capital, systolic blood pressure increased with an increasing proportion of lack of fairness, after adjustment for individual confounders.ConclusionsTo the best of our knowledge, this study is the first to investigate the association between social capital and systolic blood pressure by using a multilevel methodological framework. Surprisingly, we found that lack of fairness had a strong effect on systolic blood pressure. However, we could not find any significant associations between other items of social capital and systolic blood pressure. Further studies are needed to clarify the mechanism by which lack of fairness may have an effect on systolic blood pressure.American Journal of Hypertension (2011). doi:10.1038/ajh.2011.37.

Inhaled antibiotics for cystic fibrosis patients


Cochrane Database Syst Rev. 2011 Mar 16;3:CD001021.
Inhaled antibiotics for long-term therapy in cystic fibrosis.
Ryan G, Singh M, Dwan K.

Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Ground Floor B Block, Verdun Street, Nedlands, Western Australia 6009, Australia.
BACKGROUND: Inhaled antibiotics are commonly used to treat persistent airway infection that contributes to lung damage in people with cystic fibrosis (CF).

OBJECTIVES: To examine the evidence that inhaled antibiotic treatment in people with CF reduces frequency of exacerbations of infection, and improves lung function, quality of life and survival. To examine adverse effects of inhaled antibiotic treatment.

SEARCH STRATEGY: Trials were identified from the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register.Last search: 31 January 2011.

SELECTION CRITERIA: Trials were selected if inhaled antibiotic treatment was used for at least four weeks in people with CF, treatment allocation was randomised or quasi-randomised, and there was a control group (either placebo, no placebo or another inhaled antibiotic).

DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, judged the risk of bias and extracted data from these trials.

MAIN RESULTS: The searches identified 176 citations to 78 trials. Nineteen trials, with 1724 participants, met the inclusion criteria. Adequate meta-analysis was not possible because of the variability of study design and reporting of results. Seventeen trials with 1562 participants compared an inhaled antibiotic with placebo or usual treatment for a duration between 1 and 32 months. Inhaled tobramycin was studied in eight trials. Lung function (measured as forced expired volume in one second) was higher and exacerbations of lung infection (by different measures) were less in the antibiotic-treated group. Resistance to antibiotics increased more in the antibiotic-treated group than in placebo group when results were reported. No auditory or renal impairment was found; analysis showed tinnitus, voice alteration, hemoptysis and cough were more frequent with tobramycin than placebo. One trial, compared tobramycin with colistin in 115 participants, after one month the mean difference in forced expiratory volume at one second was 6.33 (95% confidence interval -0.04 to 12.70) favouring tobramycin.

AUTHORS' CONCLUSIONS: Inhaled antibiotic treatment probably improves lung function and reduces exacerbation rate, but a pooled estimate of the level of benefit is not possible. The best evidence is for inhaled tobramycin. More evidence, from trials of longer duration, is needed to determine whether this benefit is maintained and to determine the significance of development of antibiotic-resistant organisms.

Accuracy of cell typing in NSCLC via EBUS/EUS


Eur Respir J. 2011 Mar 15. [Epub ahead of print]
Accuracy of Cell Typing in Non-Small Cell Lung Cancer by EBUS/EUS - FNA Cytology Samples.
Wallace WA, Rassl DM.

NHS Lothian and Division of Pathology, College of Medicine and Veterinary Medicine, Edinburgh University UK.
Endoscopic ultrasound guided transbronchial or trans-oesophageal lymph node aspiration is increasingly used as a method of diagnosing non-small cell carcinoma. Data validating the accuracy of cell typing of non-small cell carcinoma using these cytology samples has not been assessed. Twenty three samples were identified in Edinburgh and a further twenty five in Cambridge with matching histological samples. The morphological cell type as assessed on the cytology preparations and cell blocks was recorded and immunohistochemical staining was performed where possible as an adjunct. The final cell type as assessed by morphology with or without immunohistochemistry was correlated with that reported in the paired histology samples. Cell blocks with tumour were available in 39/48 cases. The accuracy of cell typing when no cell block was available was 4/9, This increased to 25/39 when a cell block was available rising to 33/39 with the addition of immunohistochemistry. The overall accuracy of classification was 37/48. Accurate cell typing of non-small cell carcinomas can be performed using endoscopically derived fine needle aspirates. The importance of obtaining sufficient material for the production of cell blocks is critical in allowing optimal assessment.

Radiotherapy and targeted therapies for locally advanced NSCLC


Target Oncol. 2011 Mar 16. [Epub ahead of print]
Combination of radiotherapy and targeted therapies in the treatment of locally advanced non-small cell lung cancer.
Sacco PC, Maione P, Rossi A, Bareschino MA, Schettino C, Guida C, Elmo M, Ambrosio R, Barbato V, Zeppa R, Palazzolo G, Gridelli C.

Division of Medical Oncology, "S.G. Moscati" Hospital, Contrada Amoretta, Avellino, Italy.
Lung cancer is the most common cancer in the world. One third of patients with non-small cell lung cancer (NSCLC) are diagnosed with locally or regionally advanced unresectable disease at presentation. Currently, in this stage of disease, a combination of chemotherapy and radiotherapy is the standard treatment approach for patients with good performance status, and concomitant chemo-radiotherapy has demonstrated to be the best therapeutic approach. However, despite improvements in treatment, local tumor control remains suboptimal and distant metastases remain the major site of failure. The diversity of molecular abnormalities in NSCLC may partly contribute to its resistance to therapy. It is therefore widely accepted that one approach to improve the efficacy of cancer therapy is the development of rational combinations of anticancer agents that may exhibit synergistic interactions. The introduction of several biologic agents represents an important advance in the management of NSCLC and some of them have shown to have a synergistic effect when given in combination with radiotherapy and chemotherapy in preclinical and in clinical models. In the present review we discuss the rationale and the feasibility of these combinations and the first results available from clinical trials.

Metabolomic analysis of lung cancer patients


Lung Cancer. 2011 Mar 14. [Epub ahead of print]
A metabolomic approach to lung cancer.
Hori S, Nishiumi S, Kobayashi K, Shinohara M, Hatakeyama Y, Kotani Y, Hatano N, Maniwa Y, Nishio W, Bamba T, Fukusaki E, Azuma T, Takenawa T, Nishimura Y, Yoshida M.

Division of Respiratory Medicine, Kobe University Graduate School of Medicine, Japan.
Lung cancer is one of the most common cancers in the world, but no good clinical markers that can be used to diagnose the disease at an early stage and predict its prognosis have been found. Therefore, the discovery of novel clinical markers is required. In this study, metabolomic analysis of lung cancer patients was performed using gas chromatography mass spectrometry. Serum samples from 29 healthy volunteers and 33 lung cancer patients with adenocarcinoma (n=12), squamous cell carcinoma (n=11), or small cell carcinoma (n=10) ranging from stage I to stage IV disease and lung tissue samples from 7 lung cancer patients including the tumor tissue and its surrounding normal tissue were used. A total of 58 metabolites (57 individual metabolites) were detected in serum, and 71 metabolites were detected in the lung tissue. The levels of 23 of the 58 serum metabolites were significantly changed in all lung cancer patients compared with healthy volunteers, and the levels of 48 of the 71 metabolites were significantly changed in the tumor tissue compared with the non-tumor tissue. Partial least squares discriminant analysis, which is a form of multiple classification analysis, was performed using the serum sample data, and metabolites that had characteristic alterations in each histological subtype and disease stage were determined. Our results demonstrate that changes in metabolite pattern are useful for assessing the clinical characteristics of lung cancer. Our results will hopefully lead to the establishment of novel diagnostic tools.

From MD Anderson: Cushing Syndrome due to ectopic ACTH


Cancer. 2011 Mar 15. doi: 10.1002/cncr.26029. [Epub ahead of print]
Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion: The University of Texas MD Anderson Cancer Center Experience.
Ejaz S, Vassilopoulou-Sellin R, Busaidy NL, Hu MI, Waguespack SG, Jimenez C, Ying AK, Cabanillas M, Abbara M, Habra MA.

Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas.
BACKGROUND: Cushing syndrome (CS) secondary to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) has been described in association with a variety of tumors. The current experience with this syndrome was based on a few case series and individual case reports. Limited data were available about the tumors associated with CS-EAS in a cancer center setting. In this report, the authors have described their experience with CS-EAS at The University of Texas MD Anderson Cancer Center to further enhance the current understanding and management of this syndrome.

METHODS: This was a retrospective review of 43 patients with CS-EAS who were diagnosed between 1979 and 2009 at The University of Texas MD Anderson Cancer Center.

RESULTS: Different neuroendocrine tumors were associated with CS-EAS. Twenty-one patients (48.9%) had tumors located in the chest cavity, with bronchial carcinoid and small cell lung cancer representing the 2 most common causes. The ACTH source remained occult in 4 patients (9.3%) despite extensive workup. Clinical presentation varied, and the classic features of CS were not evident in some patients. Death occurred in 27 patients (62.8%), and the median overall survival was 32.2 months. Major morbidities included new-onset or worsening hyperglycemia (77%), symptomatic venous thromboembolism (14%), and infections (23%).

CONCLUSIONS: In patients with CS-EAS who attended a comprehensive cancer center, tumors originating in the chest cavity were the leading tumors associated with this syndrome. The authors suspect that CS-EAS is under reported because of the atypical presentation in some patients. Thus, they suggest careful evaluation of patients with neuroendocrine tumors to avoid missing coexisting CS-EAS. Cancer 2011;. © 2011 American Cancer Society.

From Chest: Lung toxicity in childhood cancer survivors


Chest. 2011 Mar 17. [Epub ahead of print]
Pulmonary outcomes in survivors of childhood cancer: a systematic review.
Huang TT, Hudson MM, Stokes DC, Krasin MJ, Spunt SL, Ness KK.

Departments of Epidemiology and Cancer Control.
AbstractBackground/Rationale: The purpose of this manuscript is to summarize the literature that documents the long-term impact of cancer treatment modalities on pulmonary function among survivors of cancer, and identify potential areas for further research.

METHODS: Systematic review of clinical trials, observational studies, case series, and review articles were conducted. Articles were limited to the studies that discussed pulmonary toxicity or late effects among pediatric cancer survivors, and to follow-up investigations that were conducted a minimum of two years after completion of cancer-related treatment or one year after hematopoietic stem cell transplant.

RESULTS: Sixty publications (51 clinical studies/reports and 9 reviews) published from January 1970 to June 2010 in PUBMED met the inclusion criteria. Data showed an association between radiotherapy, alkylating agents, bleomycin, hematopoietic stem cell transplant, and thoracic surgery and pulmonary toxicity as well as possible interactions among these modalities

CONCLUSIONS: Pulmonary toxicity is a common long-term complication of exposure to certain anticancer therapies in childhood, and can vary from sub-clinical to life-threatening. Pulmonary function and associated loss of optimal exercise capacity may have adverse effects on long-term quality of life in survivors. Lung function diminishes as a function of normal aging and the effects of early lung injury from cancer therapy may compound these changes. The information presented in this review is designed to provide a stimulus to promote both observational and interventional research that expands our knowledge and aids in design of interventions to prevent or ameliorate pulmonary late effects among survivors of childhood cancer.

Monday, March 7, 2011

Pathology of the Pleura: What the Pulmonologists Need to Know


Respirology. 2011 Mar 1. doi: 10.1111/j.1440-1843.2011.01957.x. [Epub ahead of print]

Pathology of the Pleura: What the Pulmonologists Need to Know.
Cagle PT, Allen TC.

Professor of Pathology Weill Medical College of Cornell University New York, New York Director, Pulmonary Pathology The Methodist Hospital 100 Fannin Houston, Texas 713.444.6478 Fax: 713.441.1472 pcagle@tmhs.org Professor of Pathology Chairman, Department of Pathology The University of Texas Health Science Center at Tyler 11937 US Highway 271 Tyler, Texas 75708 903.877.7883 Fax: 903.877.7964 timothy.allen@uthct.edu timallenmdjd@gmail.com.

Primary and metastatic pleural neoplasms, and non-neoplastic pleural diseases, can have similar clinical, radiographic, and gross features. However, treatments and prognoses of these diverse pleural conditions vary greatly. Accurate diagnosis of pleural disease is therefore extremely important; and histologic interpretation of pleural biopsies is vital to rendering an accurate diagnosis. Smaller biopsies contribute to the difficulties in accurately characterizing pleural lesions; and immunostains are frequently employed in their assessment. Diffuse malignant mesothelioma, the most common primary pulmonary neoplasm, is rare; however, other less common primary pleural neoplasms, including solitary fibrous tumor, the most common benign primary pleural neoplasm, occur. These neoplasms are discussed. Also, non-neoplastic pleural diseases, including granulomatous pleuritis, eosinophilic pleuritis, and fibrous and fibrinous pleuritis, among other diseases, are discussed.

© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

Wednesday, March 2, 2011

Chinese herbal treatment for diabetes-Its history is millennial, but it now requires peer-reviewed double-blind research.


Chin J Integr Med. 2011 Mar;17(3):235-40. Epub 2011 Feb 27.
Research progress on the mechanism of single-Chinese medicinal herbs in treating diabetes mellitus.
Yang LX, Liu TH, Huang ZT, Li JE, Wu LL.

Institute of Traditional Chinese Medicine, Gansu Province Academy of Chinese Medicine, Lanzhou, 730050, China.
Treating diabetes mellitus (DM) with Chinese medicine (CM) has had a few thousands years of history. Past Chinese medical texts had already recorded numerous medicinal herbs as well as recipes for treating DM and accumulated much clinical experience. In the following article, the prevention of DM using CM in the past 5 years is retrospectively studied, and mainly focuses on the usage of simple Chinese herbal extracts or monomers in terms of cellular as well as molecular biology.

From BMJ: Cystic fibrosis-improved survival in patients with low lung function


BMJ. 2011 Feb 28;342:d1008. doi: 10.1136/bmj.d1008.
Improved survival at low lung function in cystic fibrosis: cohort study from 1990 to 2007.
George PM, Banya W, Pareek N, Bilton D, Cullinan P, Hodson ME, Simmonds NJ.

Department of Cystic Fibrosis, Royal Brompton Hospital, London SW3 6NP, UK.
OBJECTIVES: To evaluate the survival of patients with cystic fibrosis whose lung function has deteriorated to a forced expiratory volume in one second (FEV(1)) below 30% predicted in the recent treatment era and to explore factors associated with any change in survival. Design Cohort study.

SETTING: Adult cystic fibrosis unit in London.

PARTICIPANTS: 276 patients (147 (53%) male) whose FEV(1) was first observed to be less than 30% predicted between 1 January 1990 and 31 December 2003.

MAIN OUTCOME MEASURE: Survival during follow-up to 31 December 2007 in two year sub-cohorts.

RESULTS: Median survival improved from 1.2 years in the 1990-1 group to 5.3 years in the 2002-3 group, with a marked improvement in survival from 1994. The use of nebulised recombinant human DNase was significantly associated with a reduced risk of death (hazard ratio 0.59, 95% confidence interval 0.44 to 0.79). Significantly increased risks were associated with a body mass index under 19 (hazard ratio 1.52, 1.10 to 2.10), long term oxygen therapy (3.52, 2.49 to 4.99), and nebulised antibiotics (1.84, 1.05 to 3.22).

CONCLUSION: A marked improvement has occurred in the survival of patients with cystic fibrosis with an FEV(1) less than 30% predicted. Secondary analyses suggest that some of this improvement may be due to use of recombinant human DNase.

Migraine and medical malpractice


Headache. 2011 Mar;51(3):434-40. doi: 10.1111/j.1526-4610.2011.01850.x.
Migraine and medical malpractice.
Evans RW, Johnston JC.

Started with Harry Truman. Will it end? Ever?


Pediatrics. 2011 Feb 28. [Epub ahead of print]
Harry Truman and Health Care Reform: The Debate Started Here.
Schremmer RD, Knapp JF.

Emergency Medical Services, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; and.
PMID: 21357338 [PubMed - as supplied by publisher]

Health coaches! Take a lap...


Hosp Top. 2011 Jan;89(1):16-22.
Introducing the health coach at a primary care practice: impact on quality and cost (part 1).
Lanese BS, Dey A, Srivastava P, Figler R.

College of Business Administration, University of Akron, Akron, Ohio.
The cost of healthcare in U.S. is a poor value proposition. One of the primary goals of the healthcare reform act is to reduce cost while improving healthcare quality. We believe that adding a health coach will help in achieving this goal. The health coach is a medical professional who supports both the physician and the patient by meeting previously established goals. This research presents and analyzes the key roles of a health coach in a primary care practice.

From U of Edinburgh: Lung cancer tissue for RNA analysis by PCR


J Thorac Oncol. 2011 Feb 23. [Epub ahead of print]
Routinely Obtained Diagnostic Material as a Source of RNA for Personalized Medicine in Lung Cancer Patients.
Andrews TD, Baird JW, Wallace WA, Harrison DJ.

*Department of Laboratory Medicine (Pathology), Royal Infirmary of Edinburgh; †Response Genetics Ltd.; and ‡Department of Pathology, Royal Infirmary of Edinburgh/University of Edinburgh.
INTRODUCTION: Therapeutic approaches to lung cancer are evolving, with personalized therapy, based on "molecular analysis" of tumors being developed. Given that approximately 90% of patients will not undergo surgery for their disease, an ability to apply these tests to small samples obtained at the time of initial pathological diagnosis is desirable. Studies in this area have produced variable results, and the minimum area of tumor tissue required for analysis has not been defined. Furthermore, such assays have not been widely applied to cytology specimens, which may be the only source of diagnostic material in many cases.

METHODS: Routinely processed biopsy and cytology specimens were microdissected to enrich for tumor cells, followed by RNA extraction using QIAGEN RNeasy kit and cDNA synthesis/reverse-transcriptase polymerase chain reaction for genes including beta-actin, ERCC-1, and RRM-1, according to standard laboratory protocols. Paired biopsy and resection specimens were similarly analyzed.

RESULTS: As little as 1 mm of tumor tissue, from a 10-μm-thick section, may be used to produce RNA suitable for analysis. RNA of adequate quality and quantity for analysis may be obtained from residual, routinely processed biopsy and cytology specimens. There is good correlation between the result obtained on the tumor biopsy specimen and paired blocks from the surgical resection with respect to clinical decision making.

CONCLUSION: Routinely processed clinical diagnostic samples provide a suitable source of RNA for polymerase chain reaction-based molecular analyses, potentially providing personalized medicine to all lung cancer patients.

From U of Pittsburgh: Lung disease in patients with systemic sclerosis


Arthritis Rheum. 2011 Mar;63(3):783-94. doi: 10.1002/art.30159.
Lung tissues in patients with systemic sclerosis have gene expression patterns unique to pulmonary fibrosis and pulmonary hypertension.
Hsu E, Shi H, Jordan RM, Lyons-Weiler J, Pilewski JM, Feghali-Bostwick CA.

University of Pittsburgh, Pittsburgh, Pennsylvania.
OBJECTIVE: Pulmonary complications, including pulmonary fibrosis (PF) and pulmonary arterial hypertension (PAH), are the leading cause of mortality in patients with systemic sclerosis (SSc). The aim of this study was to compare the molecular fingerprint of lung tissue and matching primary fibroblasts from patients with SSc with that of lung tissue and fibroblasts from normal donors, patients with idiopathic pulmonary fibrosis (IPF), and patients with idiopathic pulmonary arterial hypertension (IPAH).

METHODS: Lung tissue samples were obtained from 33 patients with SSc who underwent lung transplantation. Tissues and cells from a subgroup of SSc patients with predominantly PF or PAH were compared to those from normal donors, patients with IPF, and patients with IPAH. Microarray data were analyzed using efficiency analysis for determination of the optimal data-processing methods. Real-time polymerase chain reaction and immunohistochemistry were used to confirm differential levels of messenger RNA and protein, respectively.

RESULTS: Consensus efficiency analysis identified 242 and 335 genes that were differentially expressed in lungs and primary fibroblasts, respectively. SSc-PF and IPF lungs shared enriched functional groups in genes implicated in fibrosis, insulin-like growth factor signaling, and caveolin-mediated endocytosis. Gene functional groups shared by SSc-PAH and IPAH lungs included those involved in antigen presentation, chemokine activity, and interleukin-17 signaling.

CONCLUSION: Using microarray analysis on carefully phenotyped SSc and comparator lung tissues, we demonstrated distinct molecular profiles in tissues and fibroblasts from patients with SSc-associated lung disease compared to idiopathic forms of lung disease. Unique molecular signatures were generated that are disease specific (SSc) and phenotype specific (PF versus PAH). These signatures provide new insights into the pathogenesis and potential therapeutic targets of SSc-related lung disease.

Tuesday, March 1, 2011

Detecting lung cancer by cheek swab?


Cancer. 2011 Mar 1;117(5):881-91. doi: 10.1002/cncr.26007.
New cheek swab technique may detect lung cancer.
Printz C.

Lung cancer in patients who have quit smoking


J Cardiothorac Surg. 2011 Feb 25;6(1):19. [Epub ahead of print]
High Prevalence of Lung Cancer in a Surgical Cohort of Lung Cancer Patients A Decade After Smoking Cessation.
Mong C, Garon EB, Fuller C, Mahtabifard A, Mirocha J, Mosenifar Z, McKenna R.


BACKGROUND: This study was designed to assess the prevalence of smoking at time of lung cancer diagnosis in a surgical patient cohort referred for cardiothoracic surgery.

METHODS: Retrospective study of lung cancer patients (n= 626) referred to three cardiothoracic surgeons at a tertiary care medical center in Southern California from January 2006 to December 2008. Relationships among years of smoking cessation, smoking status, and tumor histology were analyzed with Chi-square tests.

RESULTS: Seventy-seven percent (482) had a smoking history while 11.3% (71) were current smokers. The length of smoking cessation to cancer diagnosis was <1 year for 56 (13.6%), 1-10 years for 110 (26.8%), 11-20 years for 87 (21.2%), 21-30 years for 66 (16.1%), 31-40 years for 44 (10.7%), 41-50 years for 40 (9.7%) and 51-60 years for 8 (1.9%). The mean cessation was 18.1 +/- 15.7 years (n=411 former smokers). Fifty-nine percent had stage 1 disease and 68.0% had adenocarcinoma. Squamous cell carcinoma was more prevalent in smokers (15.6% vs. 8.3%, p= 0.028); adenocarcinoma was more prevalent in never-smokers (79.9% versus 64.3%, p= 0.0004). The prevalence of adenocarcinoma varied inversely with pack year (p < 0.0001) and directly with years of smoking cessation (p = 0.0005).

CONCLUSIONS: In a surgical lung cancer cohort, the majority of patients were smoking abstinent greater than one decade before the diagnosis of lung cancer.

From Milan: Robotic minimally-invasive pneumonectomy for lung cancer


Ann Thorac Surg. 2011 Mar;91(3):e45-7.
Pneumonectomy for lung cancer: a further step in minimally invasive surgery.
Spaggiari L, Galetta D.

Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; University of Milan School of Medicine, Milan, Italy.
Robotic lobectomies have been proven to be technically and oncologically feasible. To date, however, pneumonectomy is still considered as a too extensive resection to be performed by the da Vinci robotic system (Intuitive Surgical, Mountain View, CA). We describe 2 patients with centrally located non-small cell lung cancer requiring pneumonectomy and radical lymph node dissection. The operations, consisting of a left and a right pneumonectomy, were successfully performed by a totally video-assisted robotic approach. Tips and pitfalls in this latest innovation in the minimally invasive surgery for lung cancer are discussed.

Photodynamic diagnosis: wave of the future?


Lung Cancer. 2011 Feb 24. [Epub ahead of print]
5-Aminolevulinic acid-induced fluorescence diagnosis of pleural malignant tumor.
Ali AH, Takizawa H, Kondo K, Matsuoka H, Toba H, Nakagawa Y, Kenzaki K, Sakiyama S, Kakiuchi S, Sekido Y, Sone S, Tangoku A.

Department of Respiratory Medicine, Sohag Faculty of Medicine, Sohag University, Sohag 82524, Egypt; Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 18-15 Kuramoto-cho 3, Tokushima 770-8509, Japan.
BACKGROUND: It is known that endogenously synthesized protoporphyrin IX (PpIX) following the administration of 5-aminolevulinic acid (5-ALA) is an effective photosensitizer for photodynamic diagnosis (PDD). We tested in vivo and in vitro susceptibility of human lung cancer and mesothelioma cells to photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) as a photosensitizer.

METHODS: Human lung cancer cell lines A549, Ma44-3, FT821 and human mesothelioma cell lines MSTO-211H, NCI-H290, Y-MESO-14 were incubated with 0.03% 5-ALA for 4h. After incubation, protoporphyrin IX (PpIX) fluorescence was detected using a fluorescence microscope. Pleural carcinosis was induced in severe combined immunodeficiency disease mice using the previous cell lines to test the efficacy of PDD in vivo. The mice were sacrificed 4h after oral administration of 400mg/kg of 5-ALA. We counted the visible tumors under white light then fluorescence light.

RESULTS: In vitro, clear red fluorescence was observed in all cell lines. The mean fluorescence intensity was stronger in A549 and FT821 cells than Ma44-3 cells (165.59±26.49, 157.62±18.93 vs. 104.01±17.58). Also, MSTO-211H and NCI-H290 cells had stronger fluorescence intensity than Y-MESO-14 cells (142.51±26.85, 165.16±12.91 vs. 92.31±8.69). In vivo, the tumor detection rate of fluorescence diagnosis was 1.1-4.5 times higher than that of white light. The mean number of metastases detected by the PDD was significantly higher than that of white light for FT821 (p=0.004), Ma44-3 (p=0.006) and Y-MESO-14 cell lines (p=0.005), but not for A549, NCI-H290 and MSTO-211H cell lines. Small lesions were detected by fluorescence diagnosis even though the lesions were invisible macroscopically under white light.

CONCLUSION: Our results suggest the possibility of clinical application of fluorescence diagnosis with intrapleural malignant tumors.