General thoracic and cardiovascular surgery
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The efficacy of lung cancer screening should not be evaluated by the survival rate of lung cancer patients but by lung cancer mortality in a certain population because the survival rate can be greatly affected by several types of bias. Randomized controlled trials that were conducted during the 1970s and 1980s in Europe and the United States failed to prove the efficacy of lung cancer screening in decreasing the mortality rate; but recently the results of case-control studies in Japan have revealed that undergoing currently available screening decreases the risk of lung cancer deaths by 30%-60%. A system is now being created in Japan whereby the guidelines regarding cancer screening will continue to be updated. ⋯ However, the presence of some potential bias in these studies cannot be ignored; therefore, it is still unknown whether there is actual efficacy. Several randomized controlled trials are presently in progress overseas, but the interim results were not favorable. A randomized controlled trial should therefore immediately be started in Japan as well.
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Gen Thorac Cardiovasc Surg · Oct 2009
Case ReportsIntercostal artery pseudoaneurysm after thoracoscopic lung resection.
We present a rare case of a ruptured intercostal artery pseudoaneurysm in a 59-year-old woman that occurred after a right upper lobectomy by video-assisted thoracoscopic surgery for lung cancer. The pseudoaneurysm was diagnosed by computed tomography and successfully treated with aneurysmectomy with proximal artery ligation, removing the hematoma. She improved and was discharged 1 month later.
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Gen Thorac Cardiovasc Surg · Oct 2009
Endovascular stent-grafting of anastomotic pseudoaneurysms following thoracic aortic surgery.
Anastomotic pseudoaneurysm is a rare but life-threatening complication after thoracic aortic surgery. Endovascular stent-grafting is a less invasive treatment for thoracic aortic aneurysm; however, its clinical usefulness for anastomotic pseudoaneurysms following thoracic aortic surgery is unclear. ⋯ Endovascular stent-grafting for patients with anastomotic pseudoaneurysms of the thoracic aorta following thoracic aortic surgery has become a possible optimal treatment. However, long-term outcome remains unclear, and periodical follow-up is required.
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Gen Thorac Cardiovasc Surg · Sep 2009
Case ReportsFulminant apical ballooning syndrome after replacement of a prosthetic aortic valve.
A 70-year-old woman was readmitted to our hospital with a fever of 39 degrees C on the 30th day after replacement of a prosthetic aortic valve. She required percutaneous cardiopulmonary support for her heart failure and was weaned after 7 days. Echocardiography revealed an akinetic and aneurysmally dilated left ventricular apex and hyperdynamic basal segments. This case indicates that fulminant apical ballooning syndrome might be added to the list of potential complications after cardiac surgery.
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Gen Thorac Cardiovasc Surg · Sep 2009
ReviewLung cancer-associated tumor antigens and the present status of immunotherapy against non-small-cell lung cancer.
Despite recent advances in surgery, irradiation, and chemotherapy, the prognosis of patients with lung cancer is still poor. Therefore, the development and application of new therapeutic strategies are essential for improving the prognosis of this disease. Significant progress in our understanding of tumor immunology and molecular biology has allowed us to identify the tumor-associated antigens recognized by cytotoxic T lymphocytes. ⋯ Tumor escape mechanisms from host immune surveillance remain a major obstacle for cancer immunotherapy. A better understanding of the immune escape mechanisms employed by tumor cells is necessary before we can develop a more effective immunotherapeutic approach to lung cancer. We review recent studies regarding the identification of tumor antigens in lung cancer, tumor immune escape mechanisms, and clinical vaccine trials in lung cancer.