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Naoko Miyata
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P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.16-47 - Analysis of The Novel Chest Tube (Coaxial Drain) for Lung Cancer Surgery (ID 12882)
12:00 - 13:30 | Author(s): Naoko Miyata
- Abstract
Background
The chest tube following a thoracic surgery must immediately read a sign of the postoperative abnormal findings and should be safe and effective in draining both air and fluid. The purpose here is to elucidate the efficacy of the novel chest tube （Coaxial Drain）after anatomical pulmonary resection in patients with lung malignant tumor.
a9ded1e5ce5d75814730bb4caaf49419 Method
At first, we analyzed the evacuation of air of various chest tubes (TC: Thoracic Catheter, BD: Blake drain, CD: COAXIAL DRAIN). We measured the maximum pressure and the time required for pressure to reduce under 0.2hPa. Additionally, we verified fluid emission amount and evacuation site of various chest tubes. Next, a clinical trial was performed. This study included patients who underwent anatomical pulmonary resection and mediastinal lymph node dissection for lung malignant tumor between September 2017 and April 2018. One chest tube (２4Fr.TC or ２4Fr.CD) was positioned apically and posteriorly after surgery. We reviewed the postoperative pain, the amount of chest tube drainage and the presence of subcutaneous emphysema. Pain intensity was evaluated by using The Prince Henry Hospital pain scale (PHPS), and satisfaction scores were evaluated by numeric rating scores (NRS).
4c3880bb027f159e801041b1021e88e8 Result
The decompression time of TC was the shortest and its time of CD was shorter than BD (BD>CD>TC). The fluid emission amount increased in proportion to the cross-section area of a drain (CD＞TC＞BD). All cases found no severe pain in this clinical study. There were no significant differences of pain scale between the TC group and the CD group (PHPS; p=0.83, NSR; p=0.78). No significant difference was observed in total drainage and duration of drainage both the groups. Subcutaneous emphysema occurred in 4 of 8 TC patients and 4 of 20 CD patients, indicating no significant difference between the two groups (p=0.172). There were no complications in any patient. All patients recovered and were discharged home. Moreover, all the cases in which Coaxial Drains were used obtained good wound healing at the drain insertion site.
8eea62084ca7e541d918e823422bd82e Conclusion
When air leakage occurs, air evacuation with the only BD or TC tends to be insufficient, irrespective of suction conditions. Coaxial Drains have both air inner lumen and liquid duct channels for drainage capability. Therefore, we think Coaxial Drains provide proper drainage of both airs and fluid after pulmonary resection.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.CR - Case Reports (Not CME Accredited Session) (ID 984)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.CR-31 - A Case of Thymoma with Autoimmune Hepatitis Following Preoperative Chemotherapy (ID 13065)
12:00 - 13:30 | Author(s): Naoko Miyata
- Abstract
Background
We encountered a case of thymoma with autoimmune hepatitis.
a9ded1e5ce5d75814730bb4caaf49419 Method
A 63-year-old woman was found to have an abnormal finding on chest radiography during a medical checkup, but did not seek further care. She was referred to our hospital one year later when a bilateral hilar abnormality was again found during a checkup. Chest computed tomography (CT) showed a 4.6 × 3.0 × 5.6 cm mass with calcifications in the anterior mediastinum. The tumor invaded the right lung and middle lobe, in association with a 2.0-cm daughter nodule in the head of the main tumor, with multiple pleural seeding lesions in the right thoracic cavity. Although she was asymptomatic, the anti-acetylcholine receptor antibody level was elevated to 33 nmol/L and the soluble IL-2 receptor antibody was elevated to 1,700 U/mL. The mass was diagnosed with CT-guided biopsy as a type-B2 thymic tumor (cT3N0M1a, c-Stage IV). She underwent induction chemotherapy (ADOC, 2 courses). After chemotherapy, abnormal liver enzyme levels (aspartate aminotransferase: 451 U/L, alanine aminotransferase: 529 U/L) were noted on preoperative examination. She was diagnosed with autoimmune hepatitis based on liver biopsy findings and treated with oral prednisolone 30 mg.
4c3880bb027f159e801041b1021e88e8 Result
Surgery was performed after prednisolone dose was gradually decreased to 20 mg. Extended thymectomy and pulmonary wedge resection using median sternotomy were performed. Pleural dissemination was resected using video-assisted thoracoscopic surgery. The pathological findings showed type-B3 thymic carcinoma (pT3N0M1a, p-Stage IV, Masaoka classification IVa). She was placed under observation without any additional treatment. Prednisolone dose has been gradually decreased to 15 mg without exacerbation of liver function. The anti-acetylcholine receptor antibody level decreased after surgery.
8eea62084ca7e541d918e823422bd82e Conclusion
Autoimmune diseases in association with thymoma are well known, but reports of autoimmune hepatitis are very rare. Autoimmune hepatitis must be considered when acute liver damage is observed.
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