This study aimed to investigate the correlation between serum levels of macrophage migration inhibitory factor (MIF) and the condition and prognosis of patients with traumatic brain injury (TBI).
Mediastinal paraganglioma is a rare neurogenic tumor with a hypervascular feature.The spontaneous rupture of mediastinal paraganglioma is an unusual cause of massive hemothorax.Here we present a case of 39-year-old man with massive hemothorax due to the spontaneous rupture of a mediastinal paraganglioma.The man underwent successful resection of tumor and had an uneventful recovery.To our knowledge, this is the first reported case of spontaneous rupture of nonfunctioning mediastinal paraganglioma.
Background: Circulating tumor DNA (ctDNA) is receiving more and more attention for its role in tumor screening and disease surveillance in cancer patients. However, it is unclear whether ctDNA can be used to predict recurrence and metastasis in patients after radical resection due to the resulting lower tumor burden. The published literature on postoperative ctDNA levels is also currently limited. Case Description: In this article, we report a rare case in which ctDNA accurately predicted relapse, disease progression and mechanism of resistance to epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in adjuvant setting in an EGFR-mutated lung adenocarcinoma patient. The 49-year-old male patient was a current smoker and denied any family history. Chest computed tomography (CT) scans revealed a 5.7×4.3 mass in the left upper lobe. He received adjuvant gefitinib after surgery for a stage IIIB (pT3N2M0) pulmonary adenocarcinoma. The ctDNA detection showed that the EGFR exon 19 deletion (EGFR del19) gene mutation frequencies decreased gradually and even disappeared. However, 8 months after the operation, the EGFR del19 mutation re-emerged in the blood, accompanied by a newly emerged solitary nodule (2 mm) that was later confirmed to be metastatic. Soon afterward, ctDNA detection revealed the EGFR T790M mutation, and the mediastinal lymph nodes rapidly enlarged. The patient’s treatment was switched to Osimertinib and the ctDNA detection results showed the EGFR T790M gene mutation frequencies steadily decreased to zero. During the treatment period, ctDNA detection accurately predicted each change in disease burden and revealed genotype alterations. The patient ultimately developed severe metastases in the liver after developing resistance to Osimertinib. Conclusions: This report suggests that ctDNA help monitor disease recurrence and identify genotypes in patients undergoing postoperative adjuvant EGFR-TKI therapy. More clinical researches are needed to support ctDNA is a promising tool for predicting disease progressive.
One major obstacle to the acceptance of the thoracoscopic approach of lung cancer surgery is the uncertainty as to whether the extent and quality of mediastinal lymph node dissection (MLND) are equal to those of thoracotomy.
Anatomic lung resection for lung cancer by video-assisted thoracoscopic surgery (VATS) has become popular for resectable lung cancer. However, complicated situations with hilar or interlobar lymphadenopathy were tough for surgeons.We'd like to introduce a method of "firing the bronchus and pulmonary artery together" via a video demo demonstration for troubleshooting situations with severe inflammatory or calcified peri-arterial/peri-bronchial lymphadenopathy. The inflammatory and calcified lymph nodes surrounding the target bronchus and artery were firstly dissected via sharp dissection using scissors. There was no clearance between the right lower bronchus and artery, then we fired them together using endo-stapler. At last, the stumps were shortened and reinforced via complementary cross mattress suture.This video shows a classic three portal VATS right lower lobectomy, which was complicated with severe inflammatory and calcified lymph nodes. The operation went through smoothly. The postoperative course of the patient was uneventful.If there was no clearance between the target bronchus and artery during a complicated VATS lobectomy caused by severe lymphadenopathy, firing the bronchus and pulmonary artery together was an optimal option.
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