[Objective histological grading of squamous and adenosquamous lung cancer]. / Objektiv histologisk gradering af planocellulaer og adenoskvamøs lungecancer.

The prognostic value of quantitative histopathological parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous and adenosquamous cell type. Using a projection microscope, estimates were obtained of mean nuclear volume (vV(nuc)), mean nuclear profile area, nuclear profile density, nuclear volume fraction, and mitotic profile frequency. Patient sex, age, and clinical stage was recorded. Single-factor analyses showed a prognostic significance of clinical stage and patient age (2p < or = 0.03), whereas sex was marginally significant (2p = 0.09). Of the quantitative histopathological parameters only estimates of vV(nuc) were of prognostic significance (2p = 0.02), in that small nuclear volumes were associated with the worst prognosis. In a multivariate Cox analysis, clinical stage, age, and vV(nuc) were found to be of significant, independent prognostic value. Thus, the present study indicates that vV(nuc) is of prognostic value, independent of clinical stage. The parameter is highly reproducible and easily obtained using unbiased stereology, and may be of future importance in the management of lung cancer patients.

Objective malignancy grading of squamous cell carcinoma of the lung. Stereologic estimates of mean nuclear size are of prognostic value, independent of clinical stage of disease.

BACKGROUND: The prognostic value of quantitative histopathologic parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous (N = 39) and mixed, adenosquamous (N = 16) cell type. Patients alive were followed for at least 12 years. METHODS: Using a projection microscope and a simple test system in fields of vision systematically selected from the whole tumor area of one routine section, five quantitative histopathologic variables were estimated: the mean nuclear volume, the mean nuclear profile area, the density of nuclear profiles, the volume fraction of nuclei to tissue, and the number of mitotic profiles per 10(3) nuclear profiles. For each patient, information was recorded regarding sex, age at diagnosis, and clinical stage of disease. RESULTS: Single-factor analyses showed that a favorable prognosis was associated with early clinical stages (Stages I and II) and young age (P < or = 0.03), and that females tended to do better than males (P = 0.09). Estimates of the mean nuclear volume were of prognostic significance (P = 0.02), small nuclei being associated with the worst prognosis. In a multivariate Cox analysis, clinical stage, age, and mean nuclear volume were found to be parameters of significant, independent prognostic value. CONCLUSIONS: The present feasibility study indicates that estimates of the mean nuclear volume are of prognostic value, independent of the clinical stage of disease. This quantitative histopathologic variable is highly reproducible and easily obtained using an unbiased stereologic method. Thus, the mean nuclear volume may be a parameter of future importance in the clinical management of patients with carcinoma of the lung.

The effect of fibrin glueing to seal bronchial and alveolar leakages after pulmonary resections and decortications.

In order to investigate the effect of fibrin glueing on the treatment or prevention of air leakages, 114 patients undergoing pulmonary resections and pneumonectomies were studied in two treatment groups: surgery alone (59 patients) or analogous surgical treatment followed by the application of fibrin glue (55 patients). The patients were randomly assigned to treatment groups within two strata: pulmonary resections (63 patients) and pneumonectomies (51 patients). Intraoperatively, 81% of the patients undergoing pulmonary resection who suffered from air leakages after conventional suturing showed improved results of the airway-tolerance-pressure test after the application of fibrin glue (one-sided P value < 0.01; 95% confidence interval: 58-95%). Treatment with fibrin glue reduced the incidence of postoperative leakages significantly from 66% in the control group to 39% in the treatment group (one-sided P-value < 0.02; estimated risk reduction 41%; 95% confidence interval 2-65%). An additional reduction of the duration of post-operative air leakages by the treatment with fibrin glue could not be shown. In terms of minor response criteria, slight trends for an advantage of treatment with fibrin glue could be observed for the duration of stay in hospital and the number of patients with complications. There were no obvious trends concerning fever, intraoperative and postoperative intubation times, the amount of secretion from thoracic tubes and the general condition of the patients. No adverse drug event related to fibrin glueing was observed.

Arteriographic findings in EDTA chelation therapy on peripheral arteriosclerosis.

In a randomized, double-blind, controlled study, 153 patients with claudication were each given either 20 infusions of Na2EDTA or 20 infusions of saline. Walking distances and ankle/brachial indices were measured before, during, and after treatment. In 30 patients, angiograms and transcutaneous oxygen tensions were obtained before, during, and after treatment. The patients' subjective evaluations of the effect of treatment were also recorded. It is concluded that EDTA chelation therapy has no effect in patients with intermittent claudication in the legs caused by arteriosclerosis.

Bestatin as adjuvant treatment in operated stage I and stage II non-small cell lung cancer. European Lung Cancer Study Group.

The aim of this study is to evaluate the possible effect of bestatin with respect to disease-free survival and overall survival. The study was designed as a randomized, two-armed study with surgery + bestatin in one arm, versus surgery alone in the other arm. All patients randomized are followed for 5 years or until death. By January 1st 1988, 1,030 patients had been randomized, but less than 50% were eligible after pathological staging. The data seem to show a trend in favour of bestatin in terms of disease-free survival, but the trend is far from being significant. No serious side-effects have been reported. No final conclusions can be drawn at present by April 1st 1988, but follow-up will continue and a new analysis made by April 1st 1989.

Primary lung cancer. A controlled study of preoperative and postoperative levels of circulating immune complexes.

Three complement-dependent and one rheumatoid factor-dependent immune complex assays were used to analyze the sera taken before surgery from 70 unselected and previously untreated lung cancer patients, from 30 of them after surgery, and from 31 healthy controls. Plasma levels of complement split product C3d were also analyzed. The levels of circulating immune complexes (cIC) and C3d were essentially the same in samples taken from lung cancer patients before surgery and from healthy controls. By the four immune complex assays, increased levels were found in 0 to 10% of the preoperative lung cancer patients compared to 3% of the healthy controls (not significant). The postsurgical tumor, lymph node, metastasis (pTNM) stage of the lung cancer was not reflected in the levels of cIC or C3d. Paired comparisons of the cIC and C3d levels before and after surgery did not show significant differences. Thus, we found no evidence for the occurrence of cancer-related cIC in lung cancer patients.

Sexual dysfunction as a symptom of arteriosclerosis and a complication to reconstruction of the aorto-iliac segment.

68 males were studied retrospectively after reconstructive surgery on the aorto-iliac segment with regard to sexual function pre- and postoperatively. The parameters used to evaluate the sexual dysfunctions were: penile-brachial-index (PBI), urethral pressure profile, rectal-urethral-temperature-gradient (RUTG), and urinary flow. Furthermore, in all patients a preoperative arteriogram was available and all patients were carefully interviewed on their sexual functions before and after surgery. It is concluded that PBI is a good parameter of the perfusion pressure of the internal iliac artery, which is a significant factor for erectile function. The urethral pressure profile has no relation to erectile function, but the results indicate that peroperative damage of the sympathetic nerves do have a significant influence on retrograde ejaculation postoperatively.

Four years' results of a prospective, randomized clinical trial comparing polytetrafluoroethylene and modified human umbilical vein for below-knee femoropopliteal bypass.

Polytetrafluoroethylene (PTFE) (Gore-Tex) and human umbilical vein (Biograft) arterial grafts were compared for below-knee femoropopliteal bypass grafting in a prospective randomized clinical trial. One hundred five patients (105 limbs) entered the trial. Seventy-six percent suffered from rest pain, ulceration, or gangrene. The median postoperative ankle-arm blood pressure index was 0.36. Twenty-three limbs had three patent tibial arteries, 46 limbs had two tibial arteries, 31 limbs had one patent artery, and five limbs had isolated popliteal segments. Thirty-four percent were repeat operations. Fifty-five patients were allocated to receive PTFE grafts and 50 to receive human umbilical vein grafts. The two groups were comparable as to preoperative risk factors and operative and postoperative treatment. During the first 4 years (maximum 1609 days) 40 PTFE grafts and 24 umbilical veins occluded. At 1 year the PTFE patency rate was 53% and at 4 years was 22%. For umbilical vein the corresponding figures were 74% and 42% (p = 0.005, Gehan test). During follow-up the incidence of PTFE failure was on the average 2.1 times higher than that of umbilical vein failure (95% confidence limits 1.2 to 3.4).

Pentoxifylline does not interfere with stable coumarin anticoagulant therapy: a clinical study.

A study was undertaken to investigate the possible interaction between pentoxifylline and coumarin. Ten patients on a previously stable anticoagulant treatment were investigated twice prior to, then 13 and 27 days after initiation of treatment with 1600 mg pentoxifylline daily. Coumarin therapy was continued in unaltered dosage. Parameters recorded were: bleeding time, platelet count, platelet adhesivity, spontaneous and collagen-induced platelet aggregation, activated partial thromboplastin time, prothrombin time, prothrombin-proconvertin activity, plasminogen activator and fibrin(ogen) degradation products. Platelet aggregation studies revealed a slightly higher sensitivity to collagen in 2 patients compared to pre-treatment values and in 1 patient the tendency to spontaneous aggregation was slightly increased after treatment. No other single test result changed significantly from premedication baseline values.

Distribution of intrapleural and intravenous Corynebacterium parvum in humans; 99mTc-, and 131I-labeled bacteria.

The distribution of Corynebacterium parvum labeled with 131iodine or 99mtechnetium was studied in 17 patients with bronchogenic carcinoma. The labeled bacteria were given intravenously or intrapleurally and monitored by whole-body gamma tracking and samples of blood and urine. Even though the rate of physical decay is quite different for 131iodine and 99mtechnetium, the tracking time of labeled bacteria was limited to 24 h after injection for both radioactive isotopes. Technetium labeling was preferred because of greater imaging resolution and less radiation dose to the patient. Following intravenous administration, labeled C. parvum was found predominantly in the liver and spleen, and in a lesser amount in the lung. Radioactivity was confined to the pleural cavity after intrapleural injection. These results suggest the combined intravenous and intrapleural route of adjuvant immunosupportive agents such as C. parvum for operable lung cancer patients.

A randomized clinical trial of PTFE versus human umbilical vein for femoropopliteal bypass surgery. Preliminary results.

PTFE (Goretex) and modified human umbilical vein (Biograft) vascular grafts were compared in femorodistal popliteal artery bypass surgery in a randomized clinical multicentre trial. During 18 months 104 patients (104 limbs) entered the trial. Twenty-five patients suffered from claudication, 54 suffered rest pain and 25 patients had ulceration or gangrene. The median preoperative ankle-arm blood pressure index was 0 . 34. Twenty-three limbs had 3 patent tibial arteries, 45 limbs had 2 tibial arteries, 31 limbs had 1 tibial artery while 5 limbs had an isolated popliteal segment. Thirty-six of the operations were redo-operations. Fifty-four patients were allocated to PTFE and 50 to umbilical vein. During follow-up (maximum 650 days) 24 PTFE grafts occluded against 12 umbilical veins. The 1-year patency rate was 40 per cent in the PTFE group against 75 per cent in the umbilical vein group (P = 0 . 014, Gehans test). During the first year the PTFE failure rate was on average 3 . 1 times higher than that of the umbilical vein.

Prognosis and treatment of abdominal aortic aneurysm.

The records of 109 patients operated upon for ruptured or nonruptured abdominal aortic aneurysms in the period from 1961 to 1975 were analyzed, with special attention being given to hospital mortality and the long term survival rate. It was found that a hospital mortality of 67 per cent occurred in patients operated upon for ruptured aortic aneurysms as well as a lethality rate of 40 per cent for patients operated upon urgently for nonruptured aortic aneurysms, whereas the lethality rate was only 4.5 per cent for patients operated upon electively. Subsequent to surgical treatment, an imposingly high mortality occurred in both groups of patients in relation to the normal population, so that only about 10 per cent of the patients operated upon for abdominal aortic aneurysms were living after a period of eight years. The most frequent causes of death in both groups of patients were illnesses resulting from other cardiovascular manifestations or complications in connection with the implanted prosthesis. By optional operation of the nonruptured aortic aneurysm, a gain in the number of patient years could be obtained within the first five years after the operation. However, careful evaluation of the cardiovascular status of the patient is recommended before deciding upon an operation.

Influence of porosity on the viability of the neointima. A histological investigation on implanted synthetic vascular prostheses.

The influence of porosity on the viability of the neointima was evaluated in two types of Dacron vascular prostheses with quite different porosities. It could be concluded that the observed parietal thrombus formation in functioning prostheses, and the dislodgement of the neointima in several of these, might well be attributed to the low porosity of the investigated prostheses, as compared to the recommended value. At the same time it is remarkable that no pronounced difference in the histological picture was observed in the two types of prostheses, despite large differences in their mutual porosities.