Micrometastasis in non-small-cell lung cancer: detection and staging

The clinical relevance of bone marrow micrometastasis [BMM] in non-small-cell lung cancer is undetermined, and the value of such analyses in advanced stage patients has not been clearly assessed previously. This study was conducted to estimate the accuracy of both polymerase chain reaction [PCR] and immunohistochemistry [IHC] in micrometastases detection and determine the best site for bone marrow biopsy in order to find micrometastasis. This prospective cross-sectional study was performed in the Department of Thoracic Surgery, Alzahra University Hospital from September 2008 to June 2009. To evaluate the bone marrow, a 3-cm rib segment and an aspirated specimen from the iliac bone prior to tumor resection were taken. PCR and IHC were performed for each specimen to find micrometastasis. Of 41 patients, 14 [34%] were positive for BMM by PCR compared with two positive IHC [4.8%]. All BMMs were diagnosed in rib segments, and iliac specimens were all free from metastatic lesion. Our data showed no significant association between variables such as age, sex, histology, tumor location, side of tumor, involved lobe, smoking, or weight loss and presence of BMM. PCR could use as a promising method for BMM detection. BMM in a sanctuary site [rib] is not associated with advanced stages of lung cancer. In addition, when predictor variables such as age, sex, histology, tumor location, smoking, or weight loss are analyzed, no correlation can be found between micrometastasis prevalence and any of those variables

[Lung metastasis due to limb osteogenic and soft tissue sarcoma in the hospitalized patients at Al-Zahra hospital in Isfahan between 1995 and 2008]

Soft tissue sarcoma is a relatively rare disease from mesenchymal cells . Lung metastases occur in many of the patients with limb sarcoma . The aim of this study was the evaluation of lung metastasis due to limb osteogenic and soft tissue sarcoma in the hospitalized patients at Al-Zahra hospital in Isfahan between 1995 and 2008. This descriptive cross sectional study was done on the hospitalized patients at Al-Zahra hospital in Isfahan between 1995 and 2008. Lung metastases were evaluated by lung CT scan. The data were collected from the patients' dossier and their laboratory file. We used chi-square, fisher and T test, and SPSS software [v. 11] for analyzing the collected data. We evaluated 65 patients with limb sarcoma. Lung metastases were detected in 43.3% of the patients with osteogenic sarcoma and 11.4% of the patients with soft tissue sarcoma [p=0.005]. There were no relations between occurance of lung metastases and genders, the size of the primary tumor, the side of the stricken limb, and recurrence of the tumor. The incidence of lung metastasis in the patients with osteogenic sarcoma is more than the patients with soft tissue sarcoma. In view of the fact that the incidence of lung metastasis in the patients with osteogenic sarcoma is high, we suggest that these patients be evaluated for lung metastasis

Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy

The objective of our study was to identify the incidence and risk factors of anastomotic leaks following transhiatal esophagectomy [THE]. A prospective study was conducted on 61 patients treated for carcinoma of the esophagus between 2006 and 2007. We examined the following variables: age, gender, preoperative cardiovascular function, intraoperative complications such as hypotension, arrhythmia, mediastinal manipulation period, blood loss volume, blood transfusion, duration of surgery, postoperative complications such as anastomotic leak, anastomotic stricture, requiring reoperation, respiratory complications, and total morbidity and mortality. Variables were compared between the patients with and without anastomotic leak. T-test for quantitative variables and Chi-square test for qualitative variables were used to find out any relationship. P value less than 0.05 was considered significant. Out of 61 patients, anastomotic leaks occurred in 13 [21.3%]. Weight loss, forced expiratory volume [FEV1] <2 lit, preoperative albumin, intaoperative blood loss volume, and respiratory complication were associated with the anastomotic leak in patients undergoing THE. Anastomotic leaks were the leading cause of postoperative morbidity, anastomotic stricture, and reoperation. Anastomotic leakage is a life-threatening postoperative complication. Careful attention to the factors contributing to the development of a leak can reduce the incidence of anastomotic complications postoperatively