Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.

Associação entre paracoccidioidomicose e câncer / Association between paracoccidioidomycosis and cancer

OBJETIVO: Analisar a associação entre paracoccidioidomicose (Pcm) e câncer e realizar uma revisão da literatura sobre esse tópico. MÉTODOS: Revisão retrospectiva de 25 casos diagnosticados com Pcm e câncer, extraídos de uma série de 808 casos consecutivos de pacientes adultos diagnosticados com Pcm com base nos testes realizados no Laboratório de Micologia da Santa Casa Complexo Hospitalar de Porto Alegre (RS), entre 1972 e 2007. O diagnóstico de Pcm foi confirmado através de exame microscópico direto, exame histopatológico ou imunodifusão. Todos os casos de câncer foram confirmados por exame histopatológico ou citopatológico. RESULTADOS: Sintomas respiratórios foram as principais queixas dos pacientes. O envolvimento pulmonar foi o achado mais predominante, seguido pelo tegumentar e linfático. O tipo de tumor mais prevalente foi o carcinoma brônquico, em 15 casos, seguido de outros tipos de carcinoma, e 1 paciente apresentou linfoma de Hodgkin. Em 16 pacientes (64 por cento), o sítio de Pcm era o mesmo do tumor. Na maioria dos casos, o tratamento de Pcm consistiu na administração isolada de sulfanilamida, sulfametoxazol-trimetoprim, cetoconazol, itraconazol ou anfotericina B. A cirurgia foi o tratamento mais comum para o câncer, seguida de radioterapia e quimioterapia. Dos 25 pacientes, 12 foram curados para Pcm, e 4 faleceram. Em 9, o desfecho final era desconhecido. A prevalência de câncer de pulmão na população geral na área em estudo foi significativamente maior em fumantes com Pcm que em fumantes sem Pcm (p < 0,001). CONCLUSÕES: .O diagnóstico de Pcm parece aumentar o risco de câncer de pulmão.

OBJECTIVE: To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. METHODS: A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. RESULTS: Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkin's lymphoma. In 16 patients (64 percent), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). CONCLUSIONS: A diagnosis of Pcm appears to increase the risk of lung cancer.

Acute superior vena cava obstruction causing total airway obstruction in the anaesthetic recovery room

Acute superior vena cava obstruction is commonly benign and often due to thrombosis following central venous catheterization or placement of pace maker wires. Acute obstruction due to malignancy is rare. We report a young patient known to have a malignant anterior mediastinal tumor developing acute SVC obstruction causing total airway obstruction in the anaesthetic recovery room following surgery unrelated to the Mediastinum

Etiology and outcome of superior vena cava (SVC) obstruction in adults.

Between 1997 and 2002, 107 patients with symptoms of superior vena cava (SVC) obstruction presented at a university hospital in Northeast Thailand. Age averaged 50.7 years (range, 1 to 84). The male to female ratio was 5.7:1. Duration of symptoms before diagnosis was 29.4 days (range, 2 to 240), including facial swelling, cough, and chest discomfort. About 20% of cases developed respiratory failure and 11.2% died shortly after admission. The mean hospital stay was 23.7 days. Anteroposterior and lateral chest radiographs and computed chest tomography helped locate the lesion. Transbronchial biopsy through bronchoscopy, transthoracic needle biopsy under computed tomography, lymph node biopsy, pleural fluid cytology and/or biopsy were used for histopathologic sampling. High levels of alpha-fetoprotein and beta-HCG indicated an anterior mediastinal mass. The most common etiology of SVC obstruction was bronchogenic carcinoma (51.8%), followed by an anterior mediastinal mass (14.5%), lymphoma (13.6%--with an LDH of 262 to 1459 U/l), metastatic cancer (9.1%), and acute lymphoblastic leukemia (1.8%). Benign SVC thrombosis was found in four patients with Behcet's disease or some other idiopathy. Mediastinal fibrosis from melioidosis occurred in three patients, which is rare, has not been previouly reported. Most patients (63.6%) received a combination of radiotherapy and corticosteroid and this helped 55.2% improve.

Prevalence of aspergillosis in bronchogenic carcinoma.

Bronchoalveolar lavage of 42 patients of bronchogenic carcinoma was studied to find out the prevalence of aspergillosis. Sera of the patients were also analysed for presence of anti-Aspergillus antibodies by Immunodiffusion (ID), Enzyme linked immunosorbent assay (ELISA) and dot blot assay (DBA). Aspergillus was isolated in culture from 6 (14.2%) patients of bronchogenic carcinoma. Aspergillus fumigatus was the predominant species isolated. All the strains of Aspergillus were sensitive to itraconazole, ketoconazole and amphotericin B while resistance (33.3%) was found with fluconazole. Anti-aspergillus antibodies were detected equally by ID, ELISA and DBA in 9 (21.4%) cases. The present study revealed prevalence and seroprevalance of Aspergillus in bronchogenic carcinoma to be 14.2% and 21.4% respectively. Consistent reactivity against 18 kDa Aspergillus fumigatus antigen was noted in serologically positive cases. Antibodies against 18 kDa protein antigen in western blotting may be used as a reference marker for diagnosis of aspergillosis in bronchogenic carcinoma. It is also suggested that the simplest serological technique like ID may be performed along with culture for diagnosing Aspergillosis in patients of bronchogenic carcinoma since ID, ELISA and DBA showed similar sensitivity.

Tratamiento multidisciplinario de la obstrucción de la vía aérea / Multidisciplinary treatment of airway obstruction

The airway obstruction may be for many diseases. In some cases is for malignant pathology and other cases for benign pathology. The etiology of malignant pathology may be for bronchogenic carcinoma, metastatic tumours, trachea primary tumours and larynx. The benign pathology may be for late obstruction post-tracheostomy and granulomas at many infections diseases. In this cases the most important etiology is Mycobacterium tuberculosis. The early diagnosis and the intervention of multidisciplinary group, with the participation at otorrinolaringologies, bronchoscopist, neck surgeons, chest surgeons, and radioterapeuts, can result in a best life quality and resolve the airway obstruction.

Coexisting Bronchogenic Carcinoma and Pulmonary Tuberculosis in the Same Lobe: Radiologic Findings and Clinical Significance

OBJECTIVE: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. MATERIALS AND METHODS: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. RESULTS: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). CONCLUSION: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.

Associação de carcinoma broncogênico com síndrome de Pancoast e síndrome da imunodeficiência adquirida / Association of bronchogenic carcinoma with Pancoast's syndrome and acquired immunodeficiency syndrome

É relatado o caso de um paciente portador da síndrome de Pancoast associada à síndrome da imunodeficiência adquirida. Esta apresentação é rara, visto que os tumores mais freqüentemente associados à SIDA são o sarcoma de Kaposi e o linfoma não-Hodgkin. O paciente, com passado de uso de drogas injetáveis, internou-se para investigação de massa em ápice pulmonar, com presença de síndrome de Pancoast, sendo solicitado anti-HIV, com resultado positivo, e tendo sido feito diagnóstico de Ca brônquico não-pequenas células

Carcinoma broncogênico na síndrome da imunodeficiência adquirida: relato de dois casos / Bronchogenic carcinoma in acquired immunodeficiency syndrome: report of two cases

Os autores relatam dois casos de carcinoma broncogênico em pacientes com síndrome da imunodeficiência adquirida. O primeiro caso refere-se a um paciente do sexo masculino, com 33 anos de idade, que apresentava adenocarcinoma na forma de massa hilar esquerda, com metástases nas adrenais e no baço. A evoluçäo foi desfavorável, evoluindo para o óbito em menos de um mês. O segundo caso, também de paciente do sexo masculino, com 47 anos de idade, apresentava volumosa massa no lobo superior esquerdo, com invasäo parietal e destruiçäo de arcos costais adjacentes. O estudo histopatológico demonstrou carcinoma näo-"oat-cell". Ambos receberam tratamento paliativo, pois na época do diagnóstico a doença já se encontrava em estádio avançado. Estudos recentes sugerem associaçäo entre o carcinoma broncogênico e a infecçäo pelo vírus da imunodeficiência humana, persistindo, no entanto, controvérsia quanto a um verdadeiro aumento da prevalência daquela afecçäo nos pacientes HIV-positivos

Status of lipid peroxidation and antioxidant enzymes in malignant (bronchogenic carcinoma) and non-malignant pleural effusions.

Eighty patients from Chennai Medical College (patients with bronchogenic carcinoma) and from Tambaram Tuberculosis Hospital (patients with non-malignant pulmonary diseases mainly tuberculosis) in whom the etiologic diagnosis of their pleural effusions are confirmed were included in the study. Lipid peroxidation (LPO) and activities of antioxidant enzymes were estimated in pleural exudates of the two groups. Lipid peroxidation was found to be increased and the status of antioxidants were found to be decreased in lung malignant pleural exudates when compared to those of non-malignant effusions. The possible reasons for the observed results discussed.

Tumor metastático em órbita / Metastatic tumor in the orbit

Relata-se caso de um paciente de 62 anos de idade, com diagnóstico de carcinoma brônquico e metástases generalizadas, incluindo metástase para órbita; discutem-se os aspectos da doença metastática em órbita, revisando-se a literatura especializada

Pan-hipopituitarismo por metástases hipotálamo-hipofisárias de carcinoma escamoso de pulmäo / Panhypopituitarism caused by hypothalamic-pituitary metastases of squamous cell carcinoma of the lung

A incidência de doença metastática para a regiäo hipotálamo-hipofisária é baixa (1 aa 6 por cento na maioria dos estudos), sendo o pulmäo e a próstata os sítios primários mais freqüentes no sexo masculino. A manifestaçäo clínica de pan-hipopituitarismo é rara (0,2 a 0,8 por cento) nos pacientes com diagnóstico de caarcinoma escamoso de pulmäo que durante sua evoluçäo clínica aapresentou evidências clínicas e laboratoriais de pan-hippopituitarismo, com imagem de lesäo expansiva selar e supra-selar à tomografia computadorizada.

Síndrome de inmunodeficiencia adquirida y eosinofilia pulmonar / Acquired immunodeficiency syndrome and pulmonary eosinophilia

La Enfermedad Pulmonar Eosinófila es producida por diferentes patologías, en las cuales hay un aumento de los eosinófilos tisulares y circulantes. Los mecanismos patogénicos, en la mayoría de las causas están pobremente aclarados. Entre los desórdenes que pueden desencadenarla se encuentran hipersensibilidad a drogas; secundaria a enfermedad parasitaria; micosis; vasculitis y otras enfermedades infecciosas como la tuberculosis. También puede acompañar a neoplasias como carcinoma broncogénico y enfermedad de Hodgkin. Se presenta el caso de un paciente de sexo masculino, de 45 años de edad con SIDA y Tuberculosis Pulmonar, que durante el tratamiento desarrolla eosinofilia periférica e infiltrados fugases (periféricos y bilaterales) en la radiografía de tórax. Se concluye que los pacientes con Sida y Tuberculosis, tienen mayor proporción de reacciones adversas a drogas, y que la Tuberculosis puede desencadenar per se una Eosinofilia Pulmonar Simple o Idiopática.

Pneumocystis carinii in bronchogenic carcinoma compared to other immunocompromised cancer patients using immunofluorescence and immunoperoxidase techniques

Indirect immunofluorescence [IFL] assay was used concomitantly with immunoperoxidase stain for the diagnosis of Pneumocystis carinii in 54 cancer patients with respiratory illness. The specimen analyzed was bronchoalveolar lavage fluid [BALF] in 27 patients complaining mainly of blood-tinged sputum for a period of 3-6 months with cough [group one]. Of these patients, 20 were documented by bronchoscopy and histopathology to be bronchogenic carcinoma [subgroup 1A]. Induced sputum was the test specimen in another 27 cancer patients with cough and expectoration for more than one month during receiving their chemotherapy [group two]. In subgroup 1A, eight BALF specimens showed positivity for P. carinii by both techniques. All positive cases for P. Carinii were belonging to subgroup 1A, i.e. proved bronchogenic carcinoma. The immunoperoxidase technique was slightly more specific and as sensitive as IFL. The IFL gave two false positive results as P. carinii cysts were similar to fungi under the fluorescent microscope. On the other hand, only one patient in group two was positive for P. carinii

Síndrome de compresión de la vena cava superior por quiste broncogénico gigante / Superior vena cava compression syndrome due to giant bronchogenic cyst

Se estudió un paciente masculino de 42 años de edad con quiste broncogénico gigante en el pulmón derecho que originó compresión de la vena cava superior. Como consecuencia el paciente presentaba síndrome de vena cava superior, insuficiencia respiratoria mixta crónica y corazón pulmonar, por lo que fue estudiado y se decició realizar una neumonectomía derecha. El informe de Anatomía Patológica señaló quiste broncogénico con hipoplasia pulmonar. El objetivo de este artículo es mostrar que los quistes pulmonares pueden crecer, causar compresión de la vena cava superior y con ello originar la constelación de datos clínicos radiológicos del síndrome de vena cava superior. La comprensión de vena cava superior por quistes broncogénicos no es frecuente

Fatal hemorrhage from additional primary esophageal squamous cell carcinoma in a patient previously having primary bronchogenic adenocarcinoma.

A unique occurrence is presented of additional primary epidermoid carcinoma of the esophagus with fatal bleeding into the upper digestive tract after 3 years of diagnosis of primary bronchogenic adenocarcinoma of an 81-year-old Thai man. The primary bronchogenic adenocarcinoma was surgically removed and followed by radiotherapy and chemotherapy without evidence of tumor recurrence at autopsy. The epidermoid carcinoma of the lower one-third of the esophagus metastasized to the pleura of the remaining right lung. There was no complaint of dysphagia. Outward extension through the esophageal wall rather than intraluminal protrusion of the squamous cell carcinoma was thought to result in the absence of dysphagia. Although it is uncommon physicians should be aware of the occurrence of multiple neoplasms.