ABSTRACT
Background: Bronchial carcinoid tumors are relatively rare tumors. These tumors were wrongly considered as bronchial adenomas till 3 decades ago. Now these tumors are classified as neuroendocrine bronchopulmonary tumors of lower grade of malignancy that arise from Kulchitsky cells
Aim: to study the spectrum of pulmonary carcinoids presented from our locality, demonstrating its clinicopathological profile. Also to analyze our results of surgery for these tumors and compare it with those of other centers to define the influence of the site of the tumor, carcinoid histological category , and lymph node involvement on the outcome of surgery
Patients and methods: Forty three patients with pulmonary carcinoid tumors were surgically treated at the Department of Cardiothoracie Surgery, Mansoura University Hospitals, through a period of 10 years ending December 2003. The files of all the patients were retrospectively revised for the demographic profile, clinical data, and findings of both rigid and fiberoptic bronchoscopy done to the patients. Also data extracted from CT scans and virtual CT bronchoscopy were collected and tabulated. All the patients had pulmonary resection varying from pneumonectomy till segmentectomy , according to the location and extent of the tumors. All the resectd pulmonary specimens, along with its hilar and mediastial lymph nodes were examined histopathologically, and reviewed according to the current WHO/IASLC criteria for neuroendocrine tumors. Patients were followed up from 1 to 10 years for recurrence and long term survival in relation to both typical and atypical carcinoid categories, LN affection , central and peripheral location. Results were recorded and tabulated for deduction of statistical significance
Results: The patients had a mean age of 39.35 +/- 8.55 years [range 21-64 years], 27 were females [62.79%] and 16 were males [37.3%]. Thirty five patients were symptomatic [79.1%]. Haemoptysis was the most common presenting symptom, occurring in 22 patients [51.1%]. Only 9 patients were asymptomatic [20.9 %]. Data from CT scan and bronchoscopy revealed that 29 patients [67.4%] had central tumors while 14 cases had peripheral ones. Preoperative tissue diagnosis was obtained in 22 patients [51%]. The 43 patients has 43 Operative; 21 had lobectomies, 19 had bilobectomies, one formal and one completion pneumonectomy and one segmentectomy. Typical carcinoid type was found in 35 patients [[81.3%] and eight cases had atypical carcinoid [18.7%]. Of the 35 patients with typical carcinoid. 5 had lymph node involvement [14.2%], while 3 out of 8 cases of atypical carcinoid [37.5%] showed lymph node involvement. We had one hospital mortality [2.3%] due to pulmonary embolism in an obese male aged 61 years, W. had 10 postoperative complications in 6 patients [13.9%] . We found no statistically significant correlation between the incidence of morbidity and hospital mortality and the carcinoid tissue type , place of the tumor or LN affection. Follow up: Out of the typical carcinoid group [34 surviving patients]. 29 Patients who had no LN involvement had 5 year disease free Survival of 96.55%. Out of the 5 cases with LN involvement had 5 year disease free survival 80%. Out of the atypical carcinoid group [8 surviving cases] , 5 cases who had no LN involvement had 5 year disease free survival 60%. Three cases with LN involvement, got 5 year disease free survival of 33% at the end of 5 years of follow up. By comparing results of different groups, significant predictors of 5 year disease free survival are typical carcinoid histology, absent mediastial LN involvement , and peripheral type of carcinoid
Conclusions: Carcinoid tumor is not uncommon bronchial tumor that affects females more than males. Long term survival is favorable in typical carcinoid with no LN affection, prognosis is better in peripheral type. atypical carcinoids have worse long term survival rates and recurrence Patterns, a wide surgical resection with LN clearance is essential for successful long term disease free Survival
ABSTRACT
Objective: To evaluate the homodynamic and oxygenation parameters and recovery profile of propofol-ketamine anesthesia versus sevoflurane inhalationl anesthesia, during cardiac catheterization in infants and children. Design: prospective clinical study Setting: Children Hospital, Mansoura University
Participants: Infants and children [n = 30] undergoing cardiac catheterization
Intervention: group I: anesthesia was induced with ketamine 1 mg/kg followed by a bolus of propofol 1 mg/kg. thereafter initial rate of infusion 50 micro/kg/min propofol and 20 micro/kg/min ketamine. group II: induction by sevoflurane by steadily increasing inspired concentration in increments of 1.5-2% every 3 breaths until the onset of rhythmic breathing and loss of eye lash reflex occurred. Heart rate, mean arterial blood pressure and non invasive oxygen saturation was monitored throughout the procedure
Results : Heart rate, mean arterial blood pressure and non invasive arterial oxygen saturation showed no significant differences between both groups during studied periods, The induction was significantly [P= 0.0001] shorter in propofol-ketamine group when compared with sevoflurane group. However, the extubation time [P=0.001], time to eye opening [P=0.0023] and discharge time [P= 0.01] were significantly shorter in sevoflurane group than propofol-ketamine group
Conclusion: propofol-ketamine anesthesia or sevoflurane anesthesia was associated with stable haemodynamic and oxygenation profile with more rapid induction with propofol-ketamine group but more rapid recovery with sevoflurane group