Pulmonary lobectomy for lung cancer: a prospective study to compare patients with forced expiratory volume in 1 s more or less than 80% of predicted.

OBJECTIVE: To compare post-operative course, lung function and survival of lung cancer patients with a forced expiratory volume in 1 s (FEV1) more or less than 80% of predicted submitted to lobectomy. METHODS: The data of patients undergoing lobectomy for non small cell carcinoma at the Thoracic Surgery Unit of the Ospedale Maggiore Policlinico of Milan, Italy, were prospectively collected. Inclusion criteria were a radical resectable tumor with size less than 2.5 cm, negative mediastinal nodes, capability to complete pulmonary function tests, Exclusion criteria were FEV1 <40% of predicted, pre- or post-operative chemo or radiotherapy, lobe to be resected receiving more than 30% of the perfusion, incapacity to quit smoking. RESULTS: Eighty-eight patients entered the study and were divided into two groups according to their FEV1%: 45 patients were included in control group (mean FEV1: 92.2%) and 42 in chronic obstructive pulmonary disease group (mean FEV1: 64.2%). Post-operative complications, operative mortality and actuarial survival were the same in the 2 groups. Six months after lobectomy, the mean changes in FEV1 were -14.9% for first group and -3.2% for second group (P<0.001). CONCLUSION: Lobectomy for cancer can be performed successfully also in selected patients with chronic obstructive pulmonary disease. Post-operative course and survival of these patients is not different from that of patients with normal FEV1, on the contrary, patients with low FEV1 may lose less pulmonary function or even mend it.

Hyaline vascular Castleman's disease of the mediastinum.

Castleman's disease is rare and can be present in many sites and with a variety of symptoms. Surgery is always recommended for localized lesions to remove the mass as completely as possible, reserving other treatment modalities for unresectable cases.

Prognostic significance of different biomarkers in non-small cell lung cancer.

The purpose of our study was to examine the prognostic significance of different biomarkers [DNA content, proliferating cell nuclear antigen labeling index (PCNA-LI), p53 mutation and apoptosis], in 152 surgically resected non-small cell lung cancer (NSCLC). The ploidy was carried out by densitometry; PCNA-LI, p53 and apoptosis were determined with immunohistochemistry. The results were correlated to histology, stage and patient survival. A considerable variability of the PCNA indices, ranging from 0 to 33.5% with a mean value of 7.0%, was found. DNA evaluation showed a prevalence of aneuploid tumors (62%) with a DNA index >1. Overexpression of p53 protein and apoptotic positivity were observed in low percentages of cases (16% and 32% respectively). Only stage and PCNA-LI were found to be significant prognostic factors on multivariate analysis. PCNA was superior to stage in predicting shortened survival of patients with NSCLC. PCNA immunostaining can be applied on a routine basis in formalin-fixed, paraffin-embedded samples of NSCLC to predict patient prognosis and thus to identify patients in need of additional postoperative therapies.

Buttressing staple lines with bovine pericardium in lung resection for bullous emphysema.

The utility of buttressing an endoscopic mechanical stapler with strips of bovine pericardium in resection of pulmonary bullous areas was evaluated by comparing the duration of air leakage in two randomized patient groups, one with and one without buttressing. The duration of air leakage was not related to bulla size in either group but showed a linear relation with the radiologic emphysema score in both groups (p < 0.001) and was shorter when the stapler had been fitted with bovine pericardium, but significantly reduced (p = 0.019) only in patients with a high emphysema score. The duration of air leakage was thus related to emphysema score, and in patients with high scores was shortened by application of bovine pericardium to the stapler.

CT-guided fine-needle aspiration cytology of solitary pulmonary nodules: a prospective, randomized study of immediate cytologic evaluation.

STUDY OBJECTIVE: To evaluate the immediate cytologic assessment during CT-guided fine-needle aspiration cytology (FNAC) in the diagnosis of operable indeterminate solitary pulmonary nodules (SPNs). DESIGN: Prospective randomized study. PATIENTS AND METHODS: Two hundred twenty patients with SPN undergoing CT-guided FNAC were divided into two groups. In the first one (group A, 110 patients), a cytologist assessed the adequacy of the sample obtained immediately, and when the sample was considered inadequate, fine-needle aspiration (FNA) was repeated. In the second group (B, 110 patients), an immediate cytologic examination was not performed, but only a gross assessment by the surgeon. Histologic study of the SPN was possible in 217 cases, whereas three patients were followed up radiologically. RESULTS: Adequate samples were obtained in 100% of group A and 88% of group B (p<0.001). The diagnostic accuracy was 99% in group A and 81% in group B (p<0.001). Group A required a mean of 1.22 FNAs compared with 1.10 in group B (p=0.015). The rate of pneumothorax in the whole series was 24%, and statistically significant differences between the two groups were not detected. CONCLUSIONS: Immediate cytologic study significantly increased the adequacy and diagnostic accuracy of CT-guided FNAC of indeterminate SPNs without causing a significant increase of complications.

[Videothoracoscopy in the spreading evaluation of bronchogenic cancers]. / La vidéothoracoscopie dans le bilan d'extension du cancer bronchique.

Mediastinoscopy is often necessary in management of lung cancer. Progress recently achieved in the field of thoracoscopy has led us to introduce videothoracoscopy as a complement to mediastinoscopy in preoperative management of such tumors. From June 1994 to June 1995, 113 patients presenting with stage I-IIIA lung cancer underwent a videothoracoscopy before surgery. No side-effects were observed. Results obtained in this study lead us to conclude that videothoracoscopy is useful before surgery of lung cancer.

Prospective study of surgical treatment of lung cancer in the elderly patient.

BACKGROUND: In 1986 the authors began a prospective study to investigate operative mortality and long-term survival after surgery of patients in their seventh decade of life suffering from non-small cell lung cancer in Stages I and II. METHODS: From 1986 to 1991, 519 lung cancer patients underwent radical surgery. Of this number, 54 were aged 70 years and older (Group A), while 465 fell within the 40-69 age range (Group B). The most widely applied operation in absolute terms was lobectomy (no difference between the two groups). Pneumonectomies were performed in greater number in Group B (p < .025), whereas minor resections were more numerous in Group A (p < .0005). RESULTS: Operative mortality, i.e., within 30 days of operation, was higher in the elderly patients, but without any significant difference between the two groups (A, 5.5%; B, 1.3%). Morbidity presented a very similar pattern: Group A, 7.4%; Group B, 6.9%. Actuarial survival at 2 and 5 years for the patients in Stage I was distributed as follows: Group A, 78.2% and 52.1%; Group B, 80.0% and 57.8%. CONCLUSIONS: No statistically significant difference exists between the survival rates of the two groups. The data gathered suggest that patients in their seventh decade of life can receive surgical treatment exactly as younger patients in the case of non-small cell lung cancer in Stages I and II.

[Sclerosing hemangioma of the lung: a case report]. / Emangioma sclerosante del polmone. Un caso clinico.

The authors present a case of sclerosing hemangioma, a rare benign neoplasm of the lung. The patient presented coughing, blood-tinded spuntum and thoracic pain; chest x-ray showed an irregular shadow close to right hilum. A right superior lobectomy was performed. Immunohistochemical and electronic microscopy studies of the lesion supported its origin from respiratory epithelium.

[Bronchial carcinoid tumors. Retrospective analysis of 32 cases]. / Carcinoidi bronchiali. Analisi retrospettiva di 32 casi.

Thirty-two cases of bronchial carcinoids (rate m/f = 1, average age 50.33 years) had been treated from 1970 to 1993. 62.5% of patients were symptomatic, 6% with specific symptoms. 62.5% of tumors had a central growth. Thirty-one patients underwent surgical treatment, another one a laser Nd:YAG coagulation. The operative mortality and morbidity were respectively 3% and 0%. 84.4% of tumours were typical carcinoid, 11% of those had lymphonodal metastases. Atypical carcinoids were found in 15.6% of patients, 40% had lymphnodal metastases. The global actuarial survival to 1, 5, 10 years were respectively 96, 88 and 84%. Statistically the survival difference between the typical and atypical carcinoid is relevant. The authors underline the preoperative cytologic diagnosis to perform a minimal lung resection in typical bronchial carcinoids.

Videothoracoscopy versus thoracotomy for the diagnosis of the indeterminate solitary pulmonary nodule.

The solitary pulmonary nodule often presents a diagnostic challenge to the specialist because the nature of the nodule is often indeterminate at the end of the usual diagnostic process, and operation frequently is required before a definite diagnosis can be made. We have conducted a randomized, prospective trial to evaluate the diagnostic efficacy of video-assisted thoracic surgery versus muscle-sparing lateral thoracotomy. Between January 1991 and May 1994, 44 patients suffering from solitary pulmonary nodule were divided at random into two groups: the nodule was removed in 22 cases by video-assisted thoracic surgery and in 22 cases by lateral thoracotomy. Nineteen wedge resections, 1 segmentectomy, and 2 lobectomies were performed in the first group and 13 wedge resections, 8 segmentectomies, and 1 lobectomy in the second group. An "access" thoracotomy had to be performed in 5 patients in the video-assisted thoracic surgery group. The operating room time was 97.2 +/- 32.9 minutes in the video-assisted thoracic surgery group and 130.5 +/- 14 minutes in the lateral thoracotomy group (p > 0.05). In both groups a final diagnosis was made in 100% of cases. The postoperative hospital stay was 4.6 +/- 1.08 days in the video-assisted thoracic surgery group and 7.8 +/- 0.89 days in the lateral thoracotomy group (p < 0.01). Pain was evaluated on a visual analogue scale; the scores were 26.5 +/- 11.6 in the video-assisted thoracic surgery group and 48.3 +/- 12.8 in the lateral thoracotomy group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Personal observations on surgical therapy of pulmonary metastases of renal carcinoma]. / Osservazioni personali sulla terapia chirurgica delle metastasi polmonari da carcinoma renale.

Renal cancer has an high incidence of metastasizing and its metastases are just a little responsive to chemo and radiotherapy. Because of this, thoracic surgeons began to have experiences on surgical resections of lung metastases from renal cancer. Pulmonary metastases can be isolated or multiple and may appear at the same time of renal cancer discovery or after it, and they generally have a very slow evolution. Authors report their own 15 years old experience on lung metastases from renal cancer resections.

[Indications for permanent electric electrostimulation in atrioventricular block]. / Indicazione all'elettrostimolazione elettrica permanente nei BAV.

Personal experience of pacemakers in patients suffering from (symptomatic and asymptomatic) 2nd degree AVB and 3rd degree AVB is reported.

The use of nimodipine (Nimotop-Bayer) in patients with chronic ischemic cerebral vasculopathies. Twenty-eight case reports.

Nimodipine therapy (30 mg x 3/die) was commenced in twenty-eight patients affected by chronic ischemic cerebral vasculopathies and continued for the 90 days in order to evaluate drug efficacy. Clinical controls were carried out 4, 8 and 12 weeks after the start of therapy using Doppler, ultrasound and neurological tests (the letter based on the SCAG neurological scale). Hemodynamic and hematochemical parameters were also monitored and controlled.