Chronic obstructive lung disease (COPD) is a high-risk factor for pulmonary complications in esophageal surgery. We reported a case of esophageal gastrointestinal stromal tumor (GIST) in a patient with severe COPD. Upper gastrointestinal endoscopy and computed tomography revealed a 3×2-cm submucosal tumor at the lower esophagus, and positron emission tomography showed a hypermetabolic mass (SUV(max)=5.6). Forced expiratory volume in 1 second (FEV(1)) was 33.0% of predicted and FEV(1)/forced vital capacity ratio was 40.7%. Taking the patient's lung function into account, we performed a thoracoscopic enucleation for the esophageal GIST while the patient was in a prone position. The postoperative course was uneventful and no significant change was observed in the patient's respiratory condition. Performing thoracoscopic surgery on COPD patients in a prone position is a good therapeutic alternative for reducing the occurrence of pulmonary complications.
A 42-year-old female patient experienced diplopia after two weeks of daily administration of interferon-2b and ribavirin for chronic active hepatitis C. Administration of these drugs had continued further three times a week after that and the diplopia persisted. Since brain MRI and CT angiography did not show any abnormalities, she was referred to our hospital. Neurological examination was negative except for left oculomotor nerve palsy (Fig. 1A). Blood and cerebrospinal fluid examinations and peripheral nerve conduction velocity were normal. Her oculomotor nerve palsy improved promptly after the discontinuation of interferon-2b and ribavirin, and the diplopia completely recovered after three weeks, but a slight left ptosis remained (Fig. 1B). Although interferon may cause neuropsychiatric disturbances, the incidence is quite rare. Only two cases with oculomotor nerve palsy have been reported abroad (1, 2), and this is the first Japanese case induced by combination therapy of interferon-2b and ribavirin.
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