ABSTRACT
PURPOSE: Computed tomography (CT) and [18F] Fluorodeoxyglucose positron emission tomography (FDG-PET) are considered suitable methods for the noninvasive staging of the mediastinum. Our study was intended to estimate the efficacy of contrast-enhanced helical CT (hCT) and FDG-PET, alone and combined, in the diagnosis of lymph node mediastinal metastases. METHODS: This study was a prospective and blind comparison of the efficacy of hCT and FDG-PET with two alternative reference standards, mediastinoscopy, and mediastinoscopy plus thoracotomy plus a 6-month follow-up to diagnose lymph node mediastinal metastases in 132 consecutive patients with potentially resectable non-small-cell lung cancer (NSCLC). The metastatic disease was assessed histopathologically. Further clinical information was obtained postoperatively after a median follow-up of 42 months. RESULTS: The prevalence of cN2,3 is 0.28. For hCT the sensitivity and specificity are 0.86 (95% CI, 0.70 to 0.93) and 0.67 (95% CI, 0.56 to 0.75), for PET 0.94 (95% CI, 0.81 to 0.98) and 0.59 (95% CI, 0.49 to 0.68), and for hCT and PET combined in-parallel 0.97 (95% CI, 0.84 to 0.99) and 0.44 (95% CI, 0.34 to 0.53), which translate into a negative predicted probability of 0.98 (95% CI, 0.88 to 1.00). The crude diagnostic odds ratio of PET in the total sample studied is 13.1, in the subgroup hCT+ 11.04 (3.0 to 40 0.1), and in the hCT- 3.5 (0.5 to 21.5). Similar results were obtained for hCT stratified by PET. CONCLUSION: hCT and PET perform similarly in the mediastinal staging of NSCLC, both tests are conditionally dependent and provide complementary information, and their diagnostic value mainly resides on the negative results.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Positron-Emission Tomography , Tomography, Spiral Computed , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Female , Fluorodeoxyglucose F18 , Humans , Lung Neoplasms/pathology , Lymphatic Metastasis , Male , Mediastinum , Observer Variation , Predictive Value of Tests , Prospective Studies , Radiopharmaceuticals , Sensitivity and Specificity , Single-Blind MethodABSTRACT
Postsurgical chylothorax after lung resection has an important associated rate of morbidity and mortality, and a large proportion of cases require re-exploration. The most desirable and least aggressive option is conservative treatment. The use of octreotide seems to be associated with a higher rate of resolution without the need for surgical intervention. We present 4 cases in which this drug showed excellent efficacy and minimal adverse effects in the resolution of postsurgical chylothorax.
Subject(s)
Chylothorax/drug therapy , Gastrointestinal Agents/therapeutic use , Octreotide/therapeutic use , Postoperative Complications , Adult , Aged , Chylothorax/etiology , Female , Humans , Lung Neoplasms/surgery , Male , Pneumonectomy , ThoracotomyABSTRACT
Presentamos un caso de lesión traqueal por puñalada cervical sin otras lesiones asociadas. El diagnóstico fue realizado por exploración clínica y fibrobroncoscopia flexible. Se realizó desbridamiento y anastomosis término-terminal. El paciente fue dado de alta en buen estado a los 11 días postoperatorios (AU)
We report a case of isolated tracheal injury after a cervical stab without any other cervical damage. Diagnosis was performed by bronchoscopic and clinical examination. Plastic suture was performed with end-to-end anastomosis. The patient was discharged with good health status on the eleventh postoperative day (AU)
Subject(s)
Male , Adult , Humans , Trachea/abnormalities , Trachea/injuries , Trachea/physiopathology , Thoracic Injuries/diagnosis , Thoracic Injuries/pathology , Tracheotomy/methods , Thoracic Injuries , Wounds, Penetrating , Lacerations/etiology , Lacerations/physiopathologyABSTRACT
We report a case of isolated tracheal injury after a cervical stab without any other cervical damage. Diagnosis was performed by bronchoscopic and clinical examination. Plastic suture was performed with end-to-end anastomosis. The patient was discharged with good health status on the eleventh postoperative day.
