ABSTRACT
Between March 1981 and February 1985, 93 out of 132 patients with a histologically confirmed diagnosis of malignant pleural mesothelioma were eligible for therapy and were prospectively assigned to receive either combined therapy or best supportive care, according to their personal preferences. Fifty-seven patients underwent multimodal therapy including surgical resection where possible, polychemotherapy, and radiation therapy in case of partial remission. Thirty-six patients received maximal supportive care only, as did 39 patients who were not eligible for treatment. The median survival was 13 months for treated patients compared to 7 for those receiving best supportive care and 5 for patients not amenable to treatment. Median progress-free survival was 6, 2, and 1 month respectively. Surgical resection did not prolong life expectancy within the treated group. In view of significant differences in the distribution of various cofactors over the two study groups, stepwise Cox model analyses were performed. Prognostic nontreatment variables related to prolonged survival were: good performance status, stage I and II, absence of chest pain, age below 50 years, and epithelial histology. Although in the Cox model analyses the survival improvement of patients being treated could be greatly attributed to other cofactors, multimodal treatment showed some prolongation of life expectancy.
Subject(s)
Mesothelioma/surgery , Pleural Neoplasms/surgery , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Mesothelioma/drug therapy , Mesothelioma/radiotherapy , Middle Aged , Pleural Neoplasms/drug therapy , Pleural Neoplasms/radiotherapy , Pneumonectomy , Prospective Studies , Radiotherapy DosageABSTRACT
Based upon experiences with 14 patients the clinical feasibility of transmediastinal retrocardial stimulation of the heart, of the left atrium as well as in one case of the left ventricle, is reported. Principally both can be stimulated by thus introduced pacemaker electodes. Thus on the one hand thresholds and consequently pulse effectivity appear to be a function of the electrode distance from the myocardium, whilst on the other hand the transmediastinal retrocardial thresholds are initially rather high in analogy to the majority taken from the atrial endocardial surface. Nevertheless, the transmediastinal retrocardial technique is possibly applicable for permanent cardiac pacing. However, additional tests about this are still necessary.
Subject(s)
Pacemaker, Artificial/methods , Aged , Electrodes, Implanted , Female , Heart Atria , Heart Ventricles , Humans , Male , Mediastinum , Middle AgedABSTRACT
Between March 1972 and December 1975 87 atrial leads were implanted into 85 patients. In 37 cases the transmediastinal retrocardial approach was preferred. In all the other cases the electrodes were introduced transvenous endocardially. The results showed: 1. There exist techniques of atrial lead emplacement which, when applying suitable lead designs, guarantee an anatomic stable positioning either on the left or in the right atrium. Especially the new transvenous J-shaped electrodes of type Medtronic TJL can be positioned easily. The dislodgement ratio of these leads amounts of only 6%. 2. Retro- as well as intracardially very high action voltages were found. The ones sensed by the J-tip-electrodes from the endocardial surface of the right appendage even run up to 5,4 mV. 3. In spite of relatively high initial thresholds, no exit block was seen in any of the 34 cases, in whom atrial leads were inserted transvenous endocardially for permanent atrial pacing.
