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近年，上部消化管穿孔症例（胃潰瘍穿孔，十二指腸潰瘍穿孔）に対する穿孔部閉鎖術として開腹術に比し低侵襲な腹腔鏡下手術が導入されてきている．しかし，腹腔鏡下手術は初心者には手技が困難であり手術時間が延長する．腹腔鏡補助下手術における低侵襲度と手術困難度は明らかでないので従来の開腹手術と比較検討した．腹腔鏡補助下手術（12例）では穿孔部直上に約５cmの小開腹下に，開腹手術（13例）では上腹部正中切開下に穿孔部を直接閉鎖し，有茎大網で被覆した．両群間で背景因子に差はなかった．腹腔鏡補助下群で入院期間，経口摂取までの期間は有意に短縮し，術後７日目のWBC，CRPは有意に低値であった．出血量，手術時間には有意差がなく，術後合併症，再発は両群共になかった．従って腹腔鏡補助下手術は開腹手術と比較して手術困難度は増大せず，低侵襲な術式であると考えられた．

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. A hand-held gamma probe counter was used to count the intrathoracic lymph node stations. Resected nodes were also counted to assess the accuracy of the intrathoracic counting. Results Serial scintigraphies showed that the tracer migrated through airways and the appearance resembled hot nodes. On intrathoracic counting, 50% of the nodal stations appeared positive; however, only 23% of these apparently positive nodal stations were ultimately shown to be truly radioactive. The true positive and true negative rates of detecting intrathoracic hot nodes were 100% and 56%, respectively. Because the counts of the nodal stations could include the counts from the hot primary tumor ("shine-through") or airway radioactivity, legitimate hot nodes were identified after dissecting all the apparently positive nodal stations. Two of the 9 patients in whom hot nodes were identified had nodal metastatic disease and actually had tumor cells within the hot nodes. The only complication related to the preoperative injection of technetium-99m was a minor pneumothorax. Conclusions Although radioisotope intrathoracic lymph node mapping is safe, it appears to be unsuitable for sentinel node biopsy because shine-through and the airway-migrated radioactive tracer complicated the intrathoracic counting. Only serial scintigraphy could distinguish hot nodes from airway migration.

A 71-year-old man with primary lung cancer associated with Brugada syndrome was safely oper-ated on following the placement of an implantable cardioverter defibrillator (ICD). During examinations for Brugada syndrome, a tumor in the apicoposterior segment of the left lung was incidentally detected by chest computed tomography. Following the implantation of an ICD, surgical treatment of the left lung tumor was scheduled. A lung biopsy was thoracoscopically performed and adenocarcinoma was diagnosed based on a frozen section analysis. A left upper lobectomy with lymph node dissection was performed through a standard posterolateral thoracotomy. Ventricular fibrillation, which occurred during the night of the first day following surgery, was successfully managed by the ICD.

Objective: The number of metastatic N2 stations is 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.Methods: Patients with either pathologic N1 (n=51) or N2 (n=96) NSCL who had undergone major pulmonary resection with complete mediastinal dissection were included in this retrospective study. All positive nodes were characterized by location according to the TNM classification system. The hilar station was included with the N2 stations.Results: The total number of metastatic stations in patients with N2 disease, ranged from 1 to 8 (average 2.5), whereas that in patients with N1 disease ranged from 1 to 3 (average 1.2). The incidence of multiplestation metastasis (≥3 metastatic stations) among N2 patients (35%) was significantly higher than that among N1 patients (2%) (p

We report a rare case of nonsteroidal anti-inflammatory drug-induced pneumonitis in a 72-year-old man taking diclofenac for wound pain after pulmonary resection. The pneumonitis and pleural effusion were predominant on the operative side and resolved rapidly after the diclofenac was discontinued. The diagnosis of drug-induced pneumonitis was based on a lymphocyte stimulation test that was positive for diclofenac sodium and negative for other drugs. This case report demonstrated that surgeons should be aware of the possibility of pneumonitis induced by a nonsteroidal anti-inflammatory drug.