RESUMEN
PURPOSE: To investigate the correlation between stage and histopathological characteristics of patients with lung cancer and local recurrence, as well as the incidence and the characteristics of local recurrence along with the possibility of surgical retreatment. METHODS: Studied were 51 patients with locally relapsing lung cancer, initially treated surgically from 2003 to 2007. The operations performed ranged from conservative wedge resections, standard lobectomies and pneumonectomies to extensive resections of the entire lung and chest wall. All patients underwent regular follow-up including thoracic CT scan every 3 months. RESULTS: All patients were diagnosed with local recurrence after a median of 10 months (range 1-30) after primary surgery with curative intent. There was no statistically significant link between type of surgery and time to local recurrence. Patients with pathological stage I,II, and IIIa had a significantly longer time to local recurrence than those with stage IIIb and IV. Local recurrence sites were the bronchial stump, mediastinal lymph nodes, the remaining lung parenchyma, chest wall and a combination of these. Surgical retreatment was possible in 20 of 51 patients (39.27percnt;). Chest wall was the commonest localization (20 of 51; 39.2%), also the most frequent in the group of surgically retreated patients (13 of 20; 65%). Squamous cell cancer (SCC) was the predominant histological type (38 of 51; 74.5%), followed by adenocarcinoma (9 of 51; 17.7%). CONCLUSION: SCC is the commonest locally relapsing lung cancer. The type of the initial surgical procedure didn't have any impact on the incidence of local recurrence, but the extent and completeness of surgery did. The time to local recurrence heavily depended on the primary tumor pathological stage. Chest wall was the commonest relapse site, and the most suitable for surgical retreatment, which was related to the quality of surgery.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia/cirugía , Neumonectomía , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Distribución de Chi-Cuadrado , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Serbia/epidemiología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: No method is currently available for preoperative approximation of the patient's situation to the one existing during pneumonectomy in general anesthesia with alternations of single and double-lung ventilation in the lateral position. We hypothesized that a patient breathing the room air in the sitting position, with the main bronchus occluded by the inflatable catheter (aimed to predict a postpneumonectomy ventilatory function), could, at least in some aspects, simulate the intraoperative situation in certain clinical conditions discussed in the text. To evaluate the hypothesis, we used data of 15 candidates for pneumonectomy at increased risk, who underwent a spirometry with the left man bronchus occluded, as a part of the postoperative lung function prediction. Arterial blood samples (pO2, pCO2, saturation, and pH) were obtained before placement of the Fogarty catheter, than after at least 60s of normal breathing with the main bronchus occluded. Significant drop in pO2 (10.35±1.65 vs. 7.79±1.40 kPa) ensued within 1 min after occlusion of the main bronchus. All patients were able to perform spirometry in presence of induced hypoxemia without dyspnea that would require cessation of the procedure. These results, together with the absence of cardiac rhythm disorders, lead us to believe that they would behave in the same way during a pneumonectomy with alternations of single and double-lung ventilation. Such an assumption is based on the fact that breathing the room air is less favorable from the standpoint of oxygen delivery--the content of oxygen in the room air is smaller in the room air compared to that delivered through endotracheal tube. The practical implication of this hypothesis is that assessment of oxygenation during this procedure, additionally facilitates the preoperative risk assessment in patients undergoing pneumonectomy for lung cancer. Moreover, a slight postoperative oxygenation improvement and smaller loss in FEV1 in patients with moderate COPD, mean that COPD patients are likely to do a little bit better postoperatively than predicted.
Asunto(s)
Hipoxia/complicaciones , Neoplasias Pulmonares/cirugía , Neumonectomía , Humanos , Neoplasias Pulmonares/complicaciones , Cuidados PreoperatoriosRESUMEN
BACKGROUND: Actual problem in diagnostics and therapy of lung cancer is early diagnostic and choice of diagnostic procedure. The AIM of this work was to assess the sensitivity of various histocytologic methods in diagnosis of central and peripheral lung cancer lesions. MATERIAL AND METHODS: During 2003-2004, 348 patients with lung infiltrates suspect for malignancy were treated in University of Kragujevac Clinical Center. For the preoperative diagnostics, their sputum, bronchoaspirate, aspirate obtained by fine needle percutaneous biopsy and specimens obtained by forceps biopsy during fiber-bronchoscopy were analyzed using standard cytohistology methods. RESULTS: Lung cancer was diagnozed in 155 out of 348 patients. The malignant lesions were centrally located in 123 patients (79,4%), while peripheral localization was found in 32 patients (20,6%). In the former patients, forceps biopsy was positive in 89,4%, and when combined with bronchoaspirate analysis, positive results were obtained in 91,9% of patients. In patients with peripherally located lesions, fine needly biopsy was positive in 68,8%, while citological analysis of sputum and bronchoalveolar aspirate were positive in only three (9,4%) patients. When all three methods were combined, positive results were found in 25 (78,1%) patients. CONCLUSION: The central localization of tumors was four times greater than the peripheral one. In the patients with central tumour site, the best results were obtained when forceps biopsy specimens and sputum were analysed cytologically. The combination of transcutaneous fine-needle biopsy, bronchoscopy and sputum gave the best results in the group of patients whose lesions were located peripherally.
Asunto(s)
Carcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Carcinoma/patología , Carcinoma/cirugía , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugíaRESUMEN
The goal of the palliative resection can be threefold: relief of symptoms without expected survival benefit, obviation of an urgent situation and maintenance or restoration of a good quality survival. Clear distinction should be made between this type of operation and incomplete resection: in spite of a curative intent, the latter type of operation is characterized either by residual disease or positive most distal lymph node station. Classification of palliative operations for lung cancer based on the underlying pathology seems to be most suitable for clinical use: 1) tumours without extrapulmonary extension; 2) tumours with direct involvement of adjacent organs; 3) metastatic involvement of intrathoracic or distant organs; 4) lung tumours associated with nonmalignant pathology (lung suppuration, pleural empyema). Although palliative operations for lung cancer can be considered in carefully selected patients, they should always be avoided if other, less aggressive non-surgical procedures offer the same quality of palliation.
Asunto(s)
Neoplasias Pulmonares/cirugía , Cuidados Paliativos , Humanos , Neoplasias Pulmonares/patología , Invasividad NeoplásicaRESUMEN
Clinical aspects of spontaneous pneumothorax (SP) are far more clear than some patophysiological issues. The exact mechanism that maintains adequate oxygenation in spontaneous pneumothorax of lesser size is still unclear. Experimental and rare studies in humans could not explicitely confirm whether it is hyperventilation of the nonaffected lung, still effective gas exchange within the affected lung, or hypoxic vasoconstriction. Similarly, it is unclear why the severity of dyspnoea sometimes differs between patients with the same size of SP. The idea that a certain degree of effective lung ventilation might exist in SP of lesser size was based on clinical observation of these patients on admission, on our measurements of pleural pressures and oxygenation in a group of patients with SP of different size and on rare experimental studies. Clinical observation that oxygenation was not significantly impaired in patients with SP of lesser size, without documented hyperventilation, served as a base for critical analysis of possible factors influencing oxygenation in SP of lesser size. Our hypothesis that pleural pressure swings in a partially collapsed lung, but still slightly expanding in inspiration, enable a certain degree of gas exchange, was confirmed both by several experimental studies and by our measurements. On the other hand, our clinical observation that patients with SP of greater size frequently differ in the severity of dyspnoea suggested the need of a more detailed analysis of the causes of hypoxaemia in these patients. The fact that hypoxaemia in these patients usually cannot be abolished by the existing hyperventilation, means that in SP of greater size, despite minimal lung volume, circulation in the pulmonary artery system still exists, causing right to left blood shunting. The fact that the severity of dyspnoea is not equal in all patients with complete SP means that hypoxic vasoconstriction exists only in some of them, following a still unknown pattern. Literature data and our measurements suggest that without further studies of hypoxic vasoconstriction in the acute phase of SP, the exact answer is not possible.
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Pulmón/fisiopatología , Modelos Biológicos , Neumotórax/fisiopatología , Intercambio Gaseoso Pulmonar/fisiología , Dióxido de Carbono/sangre , Disnea/etiología , Humanos , Hipoxia/etiología , Inhalación , Pulmón/irrigación sanguínea , Oxígeno/sangre , Presión Parcial , Cavidad Pleural/fisiopatología , Neumotórax/sangre , Neumotórax/complicaciones , Neumotórax/patología , Presión , Atelectasia Pulmonar/fisiopatología , Rotura Espontánea , VasoconstricciónRESUMEN
This study represents the univariate and multivariate analysis of prognostic factors of resectable non small cell-lung cancer (NSCLC) that included 360 patients who underwent a surgical treatment because of primary (NSCLC) in the aforementioned institution in a period between 1985 and 1992. Patients with incomplete resection were rejected, perioperative deaths were not included in the analysis. In the analysed group there were 2931 (81.38%) males and 67(18.62%) females--M:F ratio 4.37:1. Age of the operated patients was 36-75 years with the mean age of 55.15 years. Right-sided tumours existed in 197(54.72%) patients, left-sided tumours in 163(45.28%) patients. Based on pTNM, 157, 65, 114, 18 and 6 patients were classified into stages I, II, IIIA, IIIB and IV respectively. In the univariate analysis, survival curves were obtained using the life table method, with the statistical analysis of the obtained data using the Gehan-Wilcoxon method. In the multivariate analysis--Cox regression analysis was performed. Multivariate analysis found only T-stage, N-stage and the stage of the disease as significant independent prognostic factors. Mode of influence of factors that were found significant in the univariate analysis (age 60 years, tumour diameter 60 mm, involvement of the visceral pleura, indirect tumour signs) is discussed and compared with literature data. Survival differences depending on other factors (tumour location, bronchoscopic aspect, extent of the resection), although without statistical significance, can be useful for the clinician, in the same time contributing to the better comprehension of informations obtained by basical investigations, especially of lymphatic spread of the disease and tumour pathology.
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Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Nontraumatic subcutaneous emphysema is less frequent than traumatic. Its occurrence, unless synchronous with the treatment of spontaneous pneumothorax, usually is the consequence of exacerbation of COPD or of the obstruction of major bronchi. However, in routine clinical practice, the occurrence of subcutaneous emphysema without evident underlying disease, in combination with normal chest x-ray, still is a diagnostic and therapeutic problem. In this study typical mechanisms of this phenomenon are presented; air-trapping at the level of the main bronchus caused by endobronchial tumour growth, progressive destruction of alveoles by diffuse lung disease irrespective of its nature, and mechanism of its occurrence during dealing with the urgent clinical problem in the intensive care unit. This study does not deal with subcutaneous emphysema during the attack of severe asthma assuming it as well known situation that usually does not cause a major therapeutic problem. The sequence of necessary diagnostic and therapeutic steps is discussed taking account of possible pitfalls that usually exist in all of three described pathophysiological situations.
Asunto(s)
Enfisema Subcutáneo , Humanos , Enfisema Subcutáneo/diagnóstico , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/terapiaRESUMEN
Cytochemical examination of alveolar macrophages (AM) obtained by bronchoalveolar lavage (BAL) was performed in healthy volunteers (11 non-smokers and 11 smokers) and in 9 patients with squamous lung carcinoma (all of them smokers or ex-smokers) in order to analyze its peculiarities related to the smoking habit and to lung malignancy. Assessment of non-specific esterases: alpha-naphthyl acetate esterase (ANAE) and butyrate esterase (BUT), chloroacetate esterase (CHL), acid phosphatase (AcP), intracellular glycogen (PAS reaction), lipids (Sudan black B reaction-SBB) and iron (Perl's reaction) was performed by a semiquantitative cytochemical method (1). A significant correlation was obtained between BUT and stage of squamous lung carcinoma (varying between I and IV) (r = 0.52, p < 0.05). There was a correlation between BUT and Perl's in healthy controls (r = 0.76, p < 0.05). The same type of correlation was observed in control smokers (r = 0.64, p < 0.05), in addition to a correlation between CHL and AcP (r = 0.69, p < 0.05). There was no significant BUT/Perl's correlation in patients with squamous cell lung carcinoma (r = 0.23, p > 0.05), but significant AcP/CHL correlation as was observed in control smokers (r = 0.73, p < 0.05), and a "new" type of correlation was shown to exist between ANAE and SBB (r = 0.77, p < 0.05). In spite of the unresolved nature of lung cancer, correlation analysis of cytochemical parameters in AM might have an important part in the analysis of their relative contribution to the development of smoking-related disorders and lung malignancies.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias Pulmonares/patología , Macrófagos Alveolares/patología , Fumar/patología , Fosfatasa Ácida/análisis , Biomarcadores/sangre , Biomarcadores de Tumor/análisis , Líquido del Lavado Bronquioalveolar/citología , Hidrolasas de Éster Carboxílico/análisis , Glucógeno/análisis , Histocitoquímica , Humanos , Hierro/análisis , Lípidos/análisis , Macrófagos Alveolares/citología , Naftol AS D Esterasa/análisis , Estadificación de Neoplasias , Valores de Referencia , Cese del Hábito de Fumar , Estadísticas no ParamétricasRESUMEN
Bronchoalveolar lavage (BAL) was performed in 48 subjects: 22 healthy controls, 13 patients with pulmonary sarcoidosis Stage I and 13 patients with lung cancer. All diagnoses were pathologically and clinically confirmed. Cytocentrifuge preparations were made, air-dried and stained for cytochemical examination of alveolar macrophages (AM) using indexing and scoring methods for the evaluation of esterase activity, intracellular amounts of glycogen, lipids and iron. Significant differences were found in the cytochemical examination of enzyme activity of AM and intracellular metabolic and ionic state, depending on pathological processes and smoking habits. There was a linear correlation between alpha naphthyl esterase activity and iron content in AM in patients with squamous cell lung carcinoma and in patients with pulmonary sarcoidosis, which makes it possible to assign individual patients to one of the groups. Cytochemical examination of BAL specimens might be of great significance for the prevention and early diagnosis of various malignant and non-malignant lung diseases.
Asunto(s)
Macrófagos Alveolares/química , Lavado Broncoalveolar , Glucógeno/análisis , Humanos , Hierro/análisis , Lípidos/análisis , Macrófagos Alveolares/enzimología , Macrófagos Alveolares/fisiologíaRESUMEN
Influence of performed diagnostic and therapeutic procedures on the outcome of the treatment of traumatic hemopneumothorax during isolated chest trauma. The aim of this study is the assessment of the influence of performed diagnostic and therapeutic procedures on the outcome of hemopneumothorax as a part of isolated chest trauma. The main group consists of 51 patients with hemopneumothorax. Patients with pneumothorax without effusion represent the first control group; the second control group consist of patients treated because of iatrogenic pneumothorax. In the main and control groups the analysis of clinical, roentgenographic and functional parameters was made, together with the analysis of particular therapeutic procedures, the estimation of the success of the treatment was based on roentgenographic and functional parameters. The higher incidence of hemopneumothorax compared with control groups during chest trauma in the analyzed material is statistically significant. The occurrence of bilateral hemopneumothorax in 10% of cases emphasizes the need of adequate roentgenographic assessment of injured patients. Regardless of the intensity of the trauma, symptoms do not always indicate the existence of hemopneumothorax. The number of fractured ribs is not of significant importance in terms of the occurrence of hemopneumothorax or pneumothorax. Severe dyspnea can be accompanied even with a smaller collapse of the lung independently of the amount of blood in the pleural cavity. Oxygenation in the arterial blood is impaired with the great and small pulmonary collapse. Hemodynamic disorders existed in 14% all cases. The higher frequency of operative treatment in the main group is statistically significant. The majority of cases of traumatic hemopneumothorax can be successfully treated by the conservative treatment. Accompanying complications do not have greater influence on the outcome.
Asunto(s)
Hemoneumotórax/diagnóstico , Hemoneumotórax/terapia , Traumatismos Torácicos/complicaciones , Adulto , Hemoneumotórax/etiología , Humanos , Enfermedad Iatrogénica , Persona de Mediana Edad , Traumatismos Torácicos/terapiaRESUMEN
The authors present 100 patients operate for diseases of the trachea during a period ranging from 1972-1991. Stricture of the trachea was observed in 75% of pts. and tumours in the remaining 25%. Stricture resulting from tracheostomy was the most frequent. The majority of patients underwent end-to-end anastomosis. A Nevill prosthesis was implanted in 5 patients. The results were good in 93.34% of pts. The mortality was 6.6%. The most frequent operation for malignant tumours was resection of the trachea and end-to-end anastomosis. The length of the respected segment ranged from 3-6 cm. There was no mortality. The authors conclude that adequate preoperative diagnostic procedures unable good assessment of a lesions and a well planed operation with good results and no mortality.
Asunto(s)
Neoplasias de la Tráquea/cirugía , Estenosis Traqueal/cirugía , Humanos , Neoplasias de la Tráquea/diagnóstico , Estenosis Traqueal/diagnósticoRESUMEN
Pulmonary alveolar microlithiasis is a rare disease of unknown cause and pathogenesis, where the pathological substrate is composed of calcium microconcrements inside the alveoli. The lungs are endured with deterioration of respiratory mechanics, ventilation and perfusion disorders and finally pulmonary hypertension and chronic cor pulmonale. The disease follows a slow course extending approximately over 20 years. The authors present two cases of pulmonary alveolar microlithiasis affecting two brothers aged 14 and 19 years respectively. Radiographic findings were typical and impressive. Lung changes were discovered on recruitment in the elder brother and on examination of family members in the younger brother. Both has no complaint and normal respiratory findings. The histopathological diagnosis was made from a sample obtained by bronchoscopic-parabronchial lung biopsy. This report is completed with data from the literature.