ABSTRACT
BACKGROUND: Experience of thoracal (bronchial and thymic) carcinoid tumors is discussed to add some remarkable diagnostic and therapeutic details for their treatment, based on a retrospective clinico-pathological analysis of 152 consecutive patients operated on at the Thoracic Surgery unit in Budapest between 1974 and 1988. METHODS: Prior to surgery 70 patients were symptom free, obstructive symptoms dominated in 65 patients, and hemoptysis occurred in 23 cases. In 68 patients a peripheral coin lesion was visible in radiographs and in 81 cases the tumor could be seen by bronchoscopy. In 3 patients the neoplasm appeared as mediastinal thymic-carcinoid. Pathological confirmation was based on routine light-microscopic sections, Grimelius technique, and immunohistochemical stainings for NSE and chromogranin. Bronchoplastic procedures were performed in 28 patients and limited (wedge or segmental) resection in 21 cases. RESULTS: Atypical carcinoids were diagnosed in 18 cases, microscopic vascular invasion could be seen in 70 tumors (46%), and 12 patients had a single hilar lymph-node metastasis. Immunostaining for NSE was evident in all carcinoids and 82% of the tumors presented positive reaction for chromogranin staining. Hospital mortality was 1.3%. The 5-year-survival rate amounted to 93% and the 10-year-survival rate to 83% (126/ 152). The early postoperative deaths were among 49 patients operated on by parenchyma-sparing methods; the rest of these 49 are alive and free of symptoms. Local recurrence occurred after a lobectomy and following removal of a mediastinal carcinoid. The tumors of 23 of the 26 dead patients showed vascular invasion, but 19 neoplasms among them had neither atypia nor regional lymph-node involvement. In the group of patients having tumors with signs of microscopic vascular invasion the 10-year-survival rate was 67%, while in the others it amounted to 96%. CONCLUSIONS: Bronchial carcinoids require anatomic resection with lymph-node dissection. On the other hand, however, parenchyma-sparing methods have to be encouraged because of excellent late results. In our experience, immunohistochemistry for chromogranin can give some help in separation on the neuroendocrine tumor scale, and the presence of microscopic vascular invasivity is the main prognostic factor.
Subject(s)
Bronchial Neoplasms/surgery , Carcinoid Tumor/surgery , Adolescent , Adult , Aged , Bronchial Neoplasms/diagnostic imaging , Bronchial Neoplasms/mortality , Bronchial Neoplasms/pathology , Carcinoid Tumor/diagnostic imaging , Carcinoid Tumor/mortality , Carcinoid Tumor/pathology , Female , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Staging , Prognosis , Radiography , Retrospective Studies , Survival AnalysisABSTRACT
The physical factors are important in the regulation of immunological functions. The primary immunological process maintaining a neuroimmunological disease is influenced by the physical state. In this paper the natural killer activity was demonstrated at 50 patients with definite multiple sclerosis. One fifth of them was depressed. Significantly lower natural killer activity was found in this group unrelated to the disease activity. In the group of patients without depression significantly higher natural killer activity was present in the remission comparing the relapse. Our findings confirmed the frequent appearance of HLA DR2 configuration in multiple sclerosis. HLA differences were not found between the depressed and non-depressed groups. This results concern the role of physical factors in the disease process, but refer to other factors linked to the disease activity.
Subject(s)
Killer Cells, Natural/immunology , Multiple Sclerosis/immunology , Adult , Aged , Depression/diagnosis , Depression/psychology , Female , HLA Antigens/immunology , Humans , Male , Middle Aged , Multiple Sclerosis/psychologyABSTRACT
The authors present the case of a young male with massive haemothorax caused by intralobar bronchopulmonary sequestration. Angiography is necessary for the exact diagnosis of bronchopulmonary sequestration. The most common site of intrapulmonary type sequestration is the left lower lobe of the lung. In this case the aberrant artery was originated from the abdominal aorta. During thoracotomy after ligature of the aberrant vessels S5,S10 segmentectomy was performed. The authors emphasize that the rare cause of rapid anaemia in consequence of haemothorax could be intralobar bronchopulmonary sequestration.
Subject(s)
Bronchopulmonary Sequestration/diagnosis , Hemothorax/etiology , Adult , Bronchopulmonary Sequestration/complications , Bronchopulmonary Sequestration/surgery , Diagnosis, Differential , Humans , MaleABSTRACT
Authors analysed 25 colorectal cancer lung metastases. Among them were 13 male 12 female. Ages ranged from 45 to 70 years. The lung nodules were discovered without any symptoms in 19 cases. The disease was localized on the right in 16 patients, in 7 on the left side and 2 others were bilateral. There were 19 solitary and 6 multiple nodules. In two-third of the cases developed metastases within 3 years of colorectal interventions. In 23 cases was performed partial lung resection (wedge or lobectomy) except one pneumonectomy. In one of the patients lung biopsy was just carried out. A case presentation is detailed where the right upper lobe metastasis was resected by videothoracoscopic method. They observed no postoperative mortality. The cumulative five year survival rate is 28% (for solitary lesions 31.6%, for multiple nodules 17%).
Subject(s)
Colorectal Neoplasms/pathology , Lung Neoplasms/secondary , Aged , Female , Humans , Hungary/epidemiology , Lung Neoplasms/surgery , Male , Middle Aged , Pneumonectomy/methods , Survival Rate , Video RecordingABSTRACT
Experiences based on 75 minimal invasive intrathoracic procedures performed during a one and half--year--period are reported. The standard video thoracoscopic and mini-thoracotomy methods are compared. The possible indications are discussed, and the authors' opinion about the role of these methods in pulmonary resections is presented. They call attention to the consideration of the limits and possibilities of this new technique.
Subject(s)
Pneumonectomy/methods , Thoracoscopy/methods , Thoracotomy/methods , Adult , Female , Humans , Male , Middle Aged , Pneumonectomy/instrumentation , Television , Thoracoscopes , Thoracotomy/instrumentationABSTRACT
First experiences with minimal invasive thoracic surgery are presented. Between November 1991 and September 1992 37 intrathoracic operations--3 lobectomies among them--have been performed by their modified method. A special surgical thoracoscope was inserted through a 6-7 cm-s incision into the thorax. This instrument provides a direct view with excellent distal illumination and it also can be applied by video-thoracoscopic system. It is emphasized that their method needs further development. It's practical value and result depend on the appropriate consideration of possibilities and limits, and on careful selection of the patients.
Subject(s)
Thoracic Surgery/methods , Humans , Thoracoscopy , Video RecordingABSTRACT
Clinical and pathological review is presented of 120 patients operated on for bronchial carcinoid tumors between 1976 and 1986. The usual oncologic features were analyzed. The Grimelius reaction, immunohistochemical staining for neuron specific enolase (NSE), serotonin and chromogranin, and DNA-analysis by flow cytometry were performed in these tumors and in small cell lung cancers (SCLC). In our experience the usual oncologic criteria--atypia, tumor-size, localization, history and regional lymph node metastasis--fail to give clear information for the prognosis. The Grimelius reaction has no significant differential diagnostic importance. Immunostaining for NSE can aid in distinguishing between neuroendocrine and non-neuroendocrine pulmonary tumors. The carcinoids and SCLCs could be differentiated by immunostaining for chromogranin and by flow cytometry but none of these methods are suitable for differential diagnosis within the carcinoid group. Resection by thoracotomy is the only treatment of choice: it can provide an excellent result (the 5-year survival rate is above 90%) with a low hospital mortality (0.8%). Parenchyma-sparing resections are to be encouraged.
Subject(s)
Bronchial Neoplasms/surgery , Carcinoid Tumor/surgery , Lung Neoplasms/surgery , Adolescent , Adult , Aged , Biomarkers, Tumor/analysis , Bronchi/pathology , Bronchi/surgery , Bronchial Neoplasms/pathology , Carcinoid Tumor/pathology , Female , Humans , Immunoenzyme Techniques , Lung/pathology , Lung Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Middle Aged , Pneumonectomy , Retrospective StudiesABSTRACT
One thousand operated mediastinal tumours are analysed. Their characteristic features are discussed and some uncommon manifestations are presented. It is emphasized that in most cases (80-90%) the traditional simple X-ray methods can give a sufficient information for the diagnosis. On the other hand, vascular lesions, cervicomediastinal goiters, dumbbell neurinomas, lymphatic diseases and esophageal lesions should be detected carefully by especial diagnostic methods before surgery because of the different operative tactics and consequences. The diagnosis of the mediastinal neoplasm indicates surgery due to their compressive behaviour.
Subject(s)
Mediastinal Neoplasms/surgery , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Hungary/epidemiology , Male , Mediastinal Neoplasms/diagnostic imaging , Mediastinal Neoplasms/epidemiology , Middle Aged , RadiographyABSTRACT
The effects of initial clinical variables on short-term prognosis are analyzed in a cross-sectional study of 574 multiple sclerosis patients from 7 centers in 5 European countries. Patients with a primary progressive course had a 2.3 higher mean disability score (EDSS) than the primary remittent group after a mean duration of disease of 6.6 years. High age at onset was associated with a primary progressive course, and was also related to increased risk of a rapid shift to a secondary progressive course. Among the remittent patients without a secondary progressive course a high age at onset was significantly correlated to a higher disability score. In the whole remittent group the presence of pyramidal and cerebellar symptoms at onset predicted both a high disability score and a rapid shift to a secondary progression, while the effect was reverse for sensory and visual symptoms. No difference between the sexes was found.
Subject(s)
Disability Evaluation , Multiple Sclerosis/diagnosis , Adult , Age Factors , Europe , Female , Humans , Male , Neurologic Examination , Prognosis , Sex FactorsABSTRACT
Questions of surgical treatment are dealt with shortly when analyzing reoperations in cases of thoracic outlet syndrome. Transaxillary first rib resection is considered as a favourable solution. Authors believe that in the overwhelming majority of recurrences it is the lack of resection or insufficient resection of the first rib that can be considered as responsible for it. By the way of conclusion the importance of medical gymnastics and physiotherapy to be started in the early postoperative period is pointed out.
Subject(s)
Thoracic Outlet Syndrome/surgery , Exercise Therapy , Humans , Physical Therapy Modalities , Radiography , Recurrence , Reoperation , Ribs/surgery , Thoracic Outlet Syndrome/diagnostic imaging , Thoracic Outlet Syndrome/therapyABSTRACT
The cerebrospinal fluid (CSF) concentrations of somatostatin and neuropeptide Y were investigated by use of radioimmunoassay in patients suffering from chronic progressive multiple sclerosis. The somatostatin level was significantly decreased in the CSF of patients with multiple sclerosis compared to the control group. The magnitude of this change was more pronounced in patients with severe clinical symptoms of the illness. The CSF neuropeptide Y concentration did not differ from the control values. These findings suggest a selective involvement of somatostatin neurotransmission in multiple sclerosis.
Subject(s)
Multiple Sclerosis/cerebrospinal fluid , Neuropeptide Y/cerebrospinal fluid , Somatostatin/cerebrospinal fluid , Adult , Humans , Iodine Radioisotopes , RadioimmunoassayABSTRACT
The non-specific peroxidase (donor: H2O2-oxidoreductase, EC 1.11.1.7) activity of red blood cells in patients with multiple sclerosis, patients with other neurological diseases, and healthy control individuals was investigated. To this end, a simple method was developed. No significant difference was found in the non-specific peroxidase activity of red blood cells from patients with multiple sclerosis and controls.
Subject(s)
Erythrocytes/enzymology , Multiple Sclerosis/enzymology , Peroxidase/blood , Adult , Female , Humans , Male , Multiple Sclerosis/blood , Nervous System Diseases/blood , Nervous System Diseases/enzymology , Reference ValuesABSTRACT
Autoradiography of brain slices from 4 multiple sclerosis (MS) and 9 control patients was performed. After 6 weeks of exposure the exact picture of the white matter appeared on the X-ray films in all cases with MS, but only in one of the controls. The high level of autoradiographic signal from MS white matter suggests that an abnormal accumulation of radioactive trace elements takes place within the brains of MS victims.
Subject(s)
Autoradiography , Brain/pathology , Multiple Sclerosis/pathology , Adolescent , Adult , Aged , Animals , Dogs , Humans , Lead Poisoning/complications , Male , Middle Aged , Multiple Sclerosis/etiologyABSTRACT
The aim of this study is to examine the association between multiple sclerosis (MS) and anti-human T-lymphotropic virus type I (HTLV-I) antibody. Serum samples from 16 Hungarian caucasians with MS, 2 gipsy patients with MS, 13 Hungarian caucasians with other neurological diseases (OND) and 2 gipsy patients with OND were tested by Western blot combined with autoradiography using disrupted virus from MT-2 cell line and recombinant p24 as antigens. Negative results were obtained in all samples except for 3 Hungarian OND which were reactive to disrupted virus, but not to recombinant p24.
Subject(s)
HIV Antibodies/analysis , HIV Seropositivity/immunology , HIV-1/immunology , Multiple Sclerosis/immunology , Adult , Autoradiography , Blotting, Western , Humans , Hungary , Middle AgedABSTRACT
The diagnostic system of Bauer and that of Schumacher were compared in 75 patients whose diagnosis was then checked by autopsy (61 cases) or surgery (14 cases). Both sensitivity and specificity of Bauer's system proved to be definitely superior. Its general use is proposed.
Subject(s)
Multiple Sclerosis/diagnosis , Adult , Diagnostic Errors , Female , Humans , MaleABSTRACT
Epidemiological data of 931 patients with definite and probable multiple sclerosis in four areas in Europe (Groningen, Göttingen, Darmstadt and Baranya) were collected and compared. The same criteria and scoring methods were used. Clear differences between the areas appeared: a high percentage of severely disabled patients were encountered in the northern part (Groningen) and a high percentage of signs and symptoms related to supraspinal lesions in brainstem, cerebellum and hemispheres were found in the south east (Hungary). In Göttingen, in the central part of the total area, a relatively higher percentage of younger MS patients with minimal disability were found. However, it still has to be determined to which extent these differences are real or caused by information bias.
Subject(s)
Multiple Sclerosis/epidemiology , Female , Germany, West , Humans , Hungary , Male , NetherlandsABSTRACT
Based on a clinical and immunogenetical study of three Gipsy and two partly Gipsy patients with multiple sclerosis (MS) it is concluded that clinically the MS of pure Gipsies resembles the Eastern form of MS and that of the partly Gipsy patients the Caucasian form of the disease. In respect of histocompatibility the association of the DR2 and B7 antigens with the disease has been confirmed. By taking into account the data on the frequency of the HLA antigens in the healthy Gipsy population the genetic factors determining MS are probably only indirectly related to the B and DR loci inside the complex HLA system.
Subject(s)
Ethnicity , Multiple Sclerosis/genetics , Roma , Adult , Female , HLA Antigens/genetics , Humans , Hungary , Male , Middle Aged , Multiple Sclerosis/ethnology , Multiple Sclerosis/immunologyABSTRACT
Within a period of 17 years (1965 to 1981) 10,000 patients underwent lung resections at our dept. A reoperation was required in 392 cases. The reinterventions are classified into three groups: urgent, early and late reoperations. The proportion of urgent and early interventions is 1.2%. 392 cases are also analysed according to the type of complications, character of primary disease, as well as method of treatment. Detailed discussion is provided for the most frequent complications requiring reoperation, such as bleeding, bronchus fistula and pulmonary infarction. Viewpoints of treatment are described and method of prevention are emphasized.
