Clinical photodynamic therapy was introduced in the 1970s and has been shown to be an effective treatment modality in a variety of fields in oncology. Photodynamic therapy (PDT) is a local therapy such as radiation and surgery, which involves the photosensitization of neoplastic cells and tissues with porphyrins or related structures that catalyze, upon irradiation by laser, formation of reactive oxygen species. A photosensitizing agent is administered to the patient and after a period of 24-72 h when the concentration of the photosensitizer is maximized in tumor tissue compared with normal tissue, and then the neoplastic mass is exposed to the laser light, which initiates the necrotic process. Despite the ability of PDT to destroy the tumor selectively, it has not been applied widely due to the lack of understanding of its therapeutic mechanism and clinical experiences as well as some limitations of currently available photosensitizers. Nowadays, the number of scientific articles on PDT, regarding clinical applications as well as basic science, made its application increasing. In one of the most suitable indications, lung cancer, PDT is a minimally invasive therapeutic option for the treatment of early cancer in airway and palliation for the endobronchial obstruction from central lung cancer. In esophageal cancer, PDT can also be applied to treat in early stage without muscle invasion or remnant cancer after endoscopic mucosal resection. Besides, PDT can be applied as a part of combined modality such as a neoadjuvant or adjuvant PDT. With the advances of new sensitizers and energy delivery system, clinical application of PDT will expand in near future. This review article will focus on the basic mechanism and the clinical investigations of PDT for the clinicians.
Esophageal Neoplasms ; Humans ; Lung Neoplasms ; Photochemotherapy* ; Photosensitivity Disorders ; Photosensitizing Agents ; Porphyrins ; Reactive Oxygen Species

Carinal resection is technically demanding and the surgical risk is relatively high. When tumor is confined around the carina, then lung parenchymal sparing surgery is technically feasible in selected cases. We performed carinal resection and reconstruction without pulmonary resection for a patient suffering with squamous cell carcinoma that involved the carina and this patient had undergone right upper lobectomy 19 months previously due to lung cancer.
Carcinoma, Squamous Cell ; Humans ; Lung ; Lung Neoplasms ; Stress, Psychological

BACKGROUND: To evaluate the effects of inhaled nitric oxide (NO) and sphingosine 1-phosphate (S1P) as potential therapeutic agents of acute lung injury, we analyzed the morphology in vivo of the pulmonary microstructure using intravital videomicroscopy in a rat model of acute lung injury. MATERIAL AND METHOD: Sprague Dawley rats were divided into five groups: a control group that underwent normal saline aspiration, an acute lung injury (ALI) group that underwent hydrochloric acid aspiration, and three treatment groups that underwent hydrochloric acid aspiration and were administered therapeutic agents- the S1P group, the NO group, and the S1P+NO group (n=7 per group). To quantify alveolar compliance and interstitial edema, the diameters of all measurable alveoli and interalveolar septa were averaged at one and two hours after aspiration. Alveolar compliance was determined according to diameter changes during the respiratory cycle and the change in tidal volume. RESULT: At two hours after aspiration, the mean alveolar compliance (% change) in the ALI group decreased significantly versus the control group of rats (respiratory cycle: 1.9% for the ALI group vs 6.5% for the control group, p=0.03; tidal volume: 3.2% for the ALI group vs 9.1% for the control group, p=0.003) and versus the NO group (tidal volume: 3.2% for the ALI group vs 16.9% for the NO group, p=0.001). At two hours after aspiration, the mean interalveolar septal thickness in the NO group tended to be smaller as compared to that in the ALI group (15.2micrometer for the ALI group vs 12.3micrometer for the NO group, p=0.06). S1P did not exert a significant effect on the pulmonary microstructure of the injured rat lung. CONCLUSION: Improved alveolar compliance and reduced interstitial edema, observed by intravital videomicroscopy, suggest that inhaled NO ameliorates lung injury.
Acute Lung Injury ; Animals ; Compliance ; Edema ; Hydrochloric Acid ; Lung ; Lung Injury ; Lysophospholipids ; Microscopy, Video ; Nitric Oxide ; Rats ; Rats, Sprague-Dawley ; Sphingosine ; Tidal Volume

Benign metastasizing leiomyoma (BML) is a rare entity, characterized by the occurrence of multiple smooth muscle nodules in the lung with histologically benign leiomyoma. Both the uterine and pulmonary tumors have been found to express estrogen and progesterone receptors, which suggest that the pulmonary lesions represented metastases from leiomyoma. We experienced a 41-year-old female patient with BML and report here with the literature review.
Adult ; Estrogens ; Female ; Humans ; Leiomyoma* ; Lung Neoplasms ; Lung* ; Metastasectomy ; Muscle, Smooth ; Neoplasm Metastasis ; Receptors, Progesterone

Recurrent spontaneous pneumothorax associated with menstrual cycle was described first by Maurer in 1958. Lilington and colleague established the term 'catamenial pneumothorax' and reported 5 patients in 1972. Catamenial pneumothorax is defined as recurrent spontaneous pneumothorax occurring within 72 hours before or after the onset of menstruation, but the pathophysiology is not clearly understood. We report a recent experience of 37 years-old woman with catamenial pneumothorax, who was treated by thoracoscopic surgery.
Adult ; Female ; Humans ; Menstrual Cycle ; Menstruation ; Pneumothorax* ; Thoracoscopy*

BACKGROUND: Protection against ischemia-reperfusion injury is crucial for successful transplantation of the lung. It has been known that nitric oxide has many favorable effects on the donor lungs but at the same time, has some potential side effects of cytotoxicity. In this regards, we investigated whether the administration of nitroglycerin could decrease ischemia-reperfusion injury in isolated rat lung reperfusion model for the confirmation of the effect of nitroglycerin, a donor of nitric oxide, on lung transplantation. MATERIAL AND METHOD: 35 Sprague-Dawley species male white rats were used for this experiment. For nitroglycerin group (n=18), nitroglycerin was administered intravenously followed by mixed in flushing solution for preservation. As a control group (n=17), we used the same amount of normal saline. To evaluate the effect of nitroglycerin on the lung, heart-lung block was obtained, weighed and stored in University of Wisconsin Solution at 10oC for 24 hours. In each group of the isolated lungs, reperfusion was carried out with Krebs-Hensleit-diluted human blood for 60 minutes. As parameters of the state of the isolated lung, peak inspiratory and pulmonary arterial pressures were continuously recorded. Oxygen and carbon dioxide tension of reperfusing blood were measured before and after 30, 60 minutes of reperfusion. After sixty minutes of reperfusion, protein content in bronchoalveolar lavage fluid was measured also for the evaluation of the degree of alveolar flooding. Lung myeloperoxidase activity was determined to verify the accumulation of neutrophils. RESULTS: Although statistically significant differences were not noted in peak inspiratory and pulmonary arterial pressure between control and nitroglycerin group, latter group showed lowering tendency of pulmonary arterial pressure during the entire reperfusion period. Oxygen tension was higher (p<0.05) in nitroglycerin group compared with that of the control group, in contrast, there were no differences in carbon dioxide tension, protein content in bronchoalveolar lavage fluid and myeloperoxidase activity between the groups. In the examination of ultrastructural changes, nitroglycerin denoted the protective effect on the pulmonary architecture compared with that of control group. CONCLUSION: Collectively, on the bases of these experimental results, prior treatment of donor lung with nitroglycerin could result in better preservation of the lung. Consequently, these nitroglycerin preserved lungs are thought to be more suitable for successful transplantation of the lung.
Animals ; Arterial Pressure ; Bronchoalveolar Lavage Fluid ; Carbon Dioxide ; Flushing ; Humans ; Lung Transplantation ; Lung* ; Male ; Neutrophils ; Nitric Oxide ; Nitroglycerin* ; Organ Preservation ; Oxygen ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Wisconsin

Esophageal perforation is relatively uncommon but it often cause fatal if not properly treated, and it is associated with high morbidity and mortality. We report here on two cases of esophageal perforation caused by Boerhaave syndrome or pneumatic dilatation for treating achalasia. The patients were successfully treated with thoracoscopic primary repair and esophagomyotomy.
Dilatation ; Esophageal Achalasia* ; Esophageal Diseases ; Esophageal Perforation* ; Humans ; Mortality ; Thoracoscopy*

The operation for esophageal cancer is both complex and challenging, and may be associated with significant morbidity and mortality compared to other oncologic surgeries. Minimally invasive surgeries have been applied on various kinds of surgery to enhance better recovery with minimal surgical complications. But for the esophageal cancer, it has not been actively applied yet. With improvement in instrumentations and increasing experience with endoscopic surgical techniques, minimally invasive surgical approaches to esophageal cancer are being explored to determine feasibility, results and potential advantages. We experienced eight cases of minimally invasive surgery for esophageal cancer and report here focusing on surgical techniques and tips.
Esophageal Neoplasms* ; Laparoscopy ; Mortality ; Surgical Procedures, Minimally Invasive* ; Thoracoscopy

PURPOSE: We conducted a retrospective analysis to determine if adjuvant chemotherapy prolongs overall survival in patients with pathologic stage IB lung adenocarcinoma who had undergone complete resection and were defined as high-risk by a newly developed recurrence risk scoring model. MATERIALS AND METHODS: Patients who underwent curative resection for stage IB lung adenocarcinoma were analyzed with a newly developed recurrence risk scoring model and divided into a low-risk group and a high-risk group. The patients in the high-risk group were retrospectively divided into two groups based on whether they underwent adjuvant chemotherapy or observation. Recurrence-free survival and overall survival were compared between these two groups. RESULTS: A total of 328 patients who underwent curative resection between 2000 and 2009 were included in this study, of whom 110 (34%) received adjuvant chemotherapy and 218 (67%) underwent observation without additional treatment. According to our risk model, 167 patients (51%) were high-risk and 161 (49%) were low-risk. The 5-year recurrence-free survival rates and overall survival were 84.4% and 91.5% in low-risk patients and 53.9% and 74.7% in high-risk patients (p < 0.001). In high-risk patients, the 5-year overall survival rates were 77% among patients who underwent observation and 87% among those who underwent adjuvant chemotherapy (p=0.019). CONCLUSION: Adjuvant chemotherapy prolonged overall survival among high-risk patients who had undergone complete resection for stage IB lung adenocarcinoma.
Adenocarcinoma* ; Chemotherapy, Adjuvant* ; Humans ; Lung* ; Recurrence* ; Retrospective Studies ; Survival Rate

BACKGROUND: Goal of the initial treatment of primary spontaneous pneumothorax is re-expansion of the lung by evacuation of air from pleural space. Authors thought small caliber catheter could reach to this goal instead of conventional large bore chest tube. This retrospective study was undertaken to assess the effectiveness of 7-French (Fr) catheter for the initial treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: Between May 2003 and April 2005, 111 patients with primary spontaneous pneumothorax were managed with tube drainage; 7 Fr catheter for 86 patients and 24-French chest tube for 25 patients. We analyzed catheter indwelling time, use of analgesics, re-expansion of the lung, and catheter related problems by medical records. RESULT: Mean catheter indwelling time was 2.4+/-1.1 days in 7 Fr group and 2.3+/-1.3 days in chest tube group (p>0.05). All patients with 24 Fr catheter needed analgesics injection but never in 7Fr group. Complete re-expansion of the lung based on plane chest radiograph was obtained in 77% of 7 Fr group. The problem related with 7 Fr catheter was kinking, which showed in 5.6%. CONCLUSION: Application of the 7 Fr catheter for initial management of primary spontaneous pneumothorax was as effective as 24 Fr catheter.
Analgesics ; Catheters* ; Chest Tubes ; Drainage ; Humans ; Lung ; Medical Records ; Pneumothorax* ; Radiography, Thoracic ; Retrospective Studies