ABSTRACT
UNLABELLED: The aim of the study was to analyze the impact of extended rethymectomy in patients with myasthenia gravis. Additionally, an original technique of resternotomy is described. Extended rethymectomy was performed on 21 patients with refractory myastenic symptoms after a previous transsternal thymectomy. In 8 patients the original video-assisted technique of complete longitudinal resternotomy with the aid of a special sternal retractor elevating the sternum from above and below was used. Severe intraoperative haemorrhage from the lacerated left innominate vein occurred in 3/13 patients operated on before the video-assisted technique of resternotomy had been introduced. In none of the 8 patients operated on with video-assisted resternotomy such a complication was noted. PATHOLOGICAL FINDINGS: retained thymic lobe (4/21 patients), ectopic foci of thymic tissue (13/21 patients) no thymic tissue (4/21 patients). Results of follow-up: complete remission (11.8%), improvement (64.7%); no improvement (35.3%) during the follow-up period (mean 3.4 years). There was neither deterioration of myasthenia nor mortality during follow-up in this group. We conclude that described technique of video-assisted resternotomy reliably prevents the laceration of the heart and great vessels, and that complete remission and improvement rates in patients operated on with the extended rethymectomy are relatively low but deterioration of myasthenia is prevented.
ABSTRACT
Two cases of pulmonary mucinous cystadenoma of borderline malignancy with favourable prognosis have been reported. The discussion section contains a review of current opinion about differentiating these neoplasms from mucinous carcinomas.
Subject(s)
Cystadenocarcinoma, Mucinous/pathology , Lung Neoplasms/pathology , Adult , Cystadenocarcinoma, Mucinous/classification , Female , Humans , Lung Neoplasms/classification , Male , Middle AgedABSTRACT
A unique case of a surgically treated primary amyloid tumour of the mediastinum has been reported in a 40-year-old man. Immunohistochemical examinations revealed the presence of transthyretin and amyloid AA within the amyloid masses.
Subject(s)
Amyloidosis/pathology , Mediastinal Diseases/pathology , Adult , Amyloidosis/surgery , Humans , Male , Mediastinal Diseases/surgerySubject(s)
Bronchial Neoplasms/pathology , Carcinoma, Adenoid Cystic/pathology , Carcinoma/pathology , Cystadenoma/pathology , Adult , Aged , Diagnosis, Differential , Female , Humans , Male , Middle AgedSubject(s)
Lung Neoplasms/diagnosis , Adult , Aged , Female , Humans , Lung Neoplasms/therapy , Male , Middle Aged , Poland , Quality of Health Care , Time FactorsSubject(s)
Lung Neoplasms/diagnosis , Adult , Aged , Biopsy/methods , Bronchoscopy/methods , Evaluation Studies as Topic , Female , Humans , Lung/pathology , Male , Mediastinoscopy/methods , Middle AgedSubject(s)
Adenocarcinoma/surgery , Bronchial Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Remission, Spontaneous , Time FactorsABSTRACT
In ten specimens of resected pulmonary tissue, a little known and underscribed form of aspergillosis called tumor-like blocked pulmonary cavity with liquid content infected with aspergilli was observed. This designation was based on the finding in the specimens of tumor-like cavitary structures with blocked bronchus and contents from which abundant growth of aspergillus fumigatus was invariably obtained in cultures. Nine of the ten specimens were bronchiectasis, and one was a bronchogenic cyst. The scant literature was review, emphasizing features characteristic of this form of mycetoma and differences from the typical and frequently encountered form of ordinary pulmonary aspergilloma. The serologic response and its long duration were attributed to biological properties of aspergilli in this form caused by inaccessibility of oxygen and by occlusion of the bronchial lumen.
