RESUMEN
Diving goitres can descend the cervical region expanding directly into the thoracic cavity. In most cases, diving goitres extend into the anterosuperior compartment, but they may also extend behind the trachea. We herein present a case of a male patient with retrotracheal goitre and history of left thyroid lobectomy and median sternotomy for thoracic aortic aneurysm repair with graft placement. After detailed preoperative evaluation, the patient underwent surgical resection of the mass through a combined approach; the existing cervical incision and a right posterolateral mini-thoracotomy. The postoperative course of the patient was uncomplicated. One year after surgery, the patient is asymptomatic and disease-free. (Folia Morphol 2018; 77, 1: 166-169).
Asunto(s)
Aneurisma de la Aorta Torácica , Bocio , Glándula Tiroides , Tiroidectomía , Anciano , Aneurisma de la Aorta Torácica/patología , Aneurisma de la Aorta Torácica/cirugía , Bocio/patología , Bocio/cirugía , Humanos , Masculino , Cavidad Torácica/anomalías , Cavidad Torácica/cirugía , Glándula Tiroides/patología , Glándula Tiroides/cirugía , Tomografía Computarizada por Rayos X , Tráquea/anomalías , Tráquea/cirugíaRESUMEN
A 62-year-old male with long-standing smoking history presented with haemoptysis. Plain chest X-ray showed abnormal findings proximate to the right pulmonary hilum. Bronchoscopy revealed a fragile exophytic tumour of the right wall of the lower third of the trachea, infiltrating the right main bronchus (75% stenosis) and the right upper lobar bronchus (near total occlusion). Contrast-enhanced chest computed tomography demonstrated a 7.2 × 4.9 cm tumour contiguous to the above-mentioned structures, mediastinal lymph node pathology, and a vessel coursing inferiorly to the left of the aortic arch and anterior to the left hilum. Despite the tumour constricting the right superior vena cava (SVC), no signs of SVC syndrome were present. In this case, the patient does not present with SVC syndrome, as expected due to the constriction of the (right) SVC caused by the tumour, since head and neck veins drain through the persistent left superior vena cava (PLSVC). PLSVC is the most common thoracic venous anomaly with an incidence of 0.3% to 0.5% of the general population and it is a congenital anomaly caused by the failure of the left anterior cardinal vein to regress and to consequently form the ligament of Marshall during foetal development. It is associated with absence of the left brachiocephalic vein and in 10% to 20% of cases the right SVC is absent. Two potential draining points of the PLSVC have been previously reported. In the majority of cases PLSVC drains directly into the coronary sinus, but less frequently it drains into the left atrium or the left superior pulmonary vein (LSPV). In cases where the PLSVC drains into the coronary sinus, congenital heart defects are rare. The patient usually remains asymptomatic and PLSVC is an incidental finding during radiographic imaging or medical procedures. When the PLSVC drains into the left atrium or the LSPV, a right-to-left shunt is formed; a condition usually asymptomatic. In some reported cases this PLSVC variant presents with persistent, unexplained hypoxia or cyanosis and embolisation causing recurrent transient ischaemic attacks and/or cerebral abscesses. This PLSVC variant is more often associated with absence of the right SVC and congenital heart abnormalities.
RESUMEN
PURPOSE: Stage IV disease at initial presentation ac-counts for approximately 41% of newly diagnosed cases with non-small cell lung cancer (NSCLC). Although the majority of these patients have disseminated metastatic disease at diagnosis, a small percentage of them are found to have a solitary site of extrathoracic metastasis. In addition, patients who have received surgical or multimodality treatment with curative intent may experience metachronous solitary distant recurrences during the natural course of their disease. Our aim was to review the possible role of surgical resection in the management of NSCLC with solitary hematogenous metastasis. METHODS: We performed electronic literature search of PubMed, EMBASE and the Cochrane Library for articles in English using a number of key words. RESULTS: All identified studies reported survival benefit for patients operated for their single metastatic lesion. Patients with metachronous disease had slightly better prognosis than those with synchronous metastatic lesions. We found no prospective randomized trials comparing surgical and non-surgical treatment modalities for NSCLC with solitary hematogenous metastasis. CONCLUSIONS: Available evidence supports the presumption that in highly selected patients with isolated synchronous or metachronous hematogenous metastasis surgical resection as part of an aggressive approach positively affects patients' survival. Factors that are in favor of a satisfactory outcome include control of primary site, confirmed solitary metastatic disease, good performance status (PS), metachronous lesions and longer disease-free interval (DFI). Prospective randomized trials are necessary to provide stronger evidence. Finally, it is worth investigating the biology of these tumors presenting with single-site distant metastasis.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Metastasectomía , Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , HumanosAsunto(s)
Hematoma/etiología , Síndromes Mielodisplásicos/complicaciones , Complicaciones Posoperatorias/etiología , Enfermedades Torácicas/etiología , Anciano , Hematoma/patología , Humanos , Masculino , Derrame Pleural/etiología , Derrame Pleural/cirugía , Complicaciones Posoperatorias/patología , Enfermedades Torácicas/patología , Pared Torácica/patologíaRESUMEN
Thymic cysts (TCs) represent 1-2% of all mediastinal masses. To the best of our knowledge transudative effusion due to rupture of a TC into the pleural cavity, as it happened with our patient, has never been described before. The patient was admitted in 5th Department of Respiratory Medicine of "SOTIRIA" Hospital complaining of pleuritic chest pain in the right hemithorax and dyspnea on exertion. Clinical and laboratory examinations indicated a right pleural effusion. Then, the patient was transferred to the 2nd Department of Propedeutic Surgery of 'LAIKO' Hospital where he underwent surgery. Video-assisted thoracic surgery (VATS) revealed an enormous 25-cm cyst ruptured into the right pleural cavity. The cyst was removed by open thoracotomy due to adhesion to contiguous tissues. Pathological examination indicated thymic origins.
Asunto(s)
Quiste Mediastínico/complicaciones , Enfermedades Pleurales/etiología , Femenino , Humanos , Quiste Mediastínico/diagnóstico por imagen , Persona de Mediana Edad , Cavidad Pleural , Enfermedades Pleurales/diagnóstico por imagen , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/etiología , Tomografía Computarizada por Rayos XRESUMEN
AIMS OF THE STUDY: The aim of this study was to evaluate the role of liquid-based cytology with the ThinPrep (TP) (Cytyc; Cytyc, Co, Boxborough, MA, USA) technique, using fine-needle aspiration (FNA) for sampling, in the investigation of suspicious pulmonary lesions. METHODS: We performed percutaneous computed tomography (CT)-guided FNA biopsy of focal pulmonary lesions in 80 adult patients. Study subjects were all consecutive patients and potential candidates for surgery. The sample was then examined by both conventional smears (CS) and TP techniques. TP smears of all FNA were prepared from needle rinsing obtained following preparation of CS. All cytological diagnoses were correlated with the CS and/or thoracotomy histological diagnoses in order to evaluate the role of liquid-based cytology with the TP technique. RESULTS: Using TP technique diagnosis was successfully established in 75 patients out of 80, whereas using CS cytology diagnosis was established in 54 patients (p<0.001, z=3899). Inadequate material was observed in 5 cases (6.25%) with the TP technique and in 13 cases (16.25%) with the CS technique (z=-2.77, p<0.05). CONCLUSIONS: We believe that the TP technique has a good overall yield for the diagnosis of suspicious for malignant lung lesions. We found that the accuracy of determining lung cancer was excellent.
Asunto(s)
Citodiagnóstico/métodos , Neoplasias Pulmonares/diagnóstico , Pulmón/patología , Carcinoma/diagnóstico , Femenino , Hamartoma/diagnóstico , Humanos , Linfoma no Hodgkin/diagnóstico , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Tomografía Computarizada por Rayos XAsunto(s)
Enfermedades Óseas Infecciosas/diagnóstico por imagen , Equinococosis/diagnóstico por imagen , Enfermedades Pleurales/diagnóstico por imagen , Costillas , Infecciones de los Tejidos Blandos/diagnóstico por imagen , Adulto , Enfermedades Óseas Infecciosas/parasitología , Enfermedades Óseas Infecciosas/terapia , Equinococosis/terapia , Femenino , Humanos , Enfermedades Pleurales/parasitología , Enfermedades Pleurales/terapia , Infecciones de los Tejidos Blandos/parasitología , Infecciones de los Tejidos Blandos/terapia , Tomografía Computarizada por Rayos XAsunto(s)
Neumonía Neumocócica/etiología , Estenosis Traqueal/etiología , Divertículo de Zenker/complicaciones , Esófago/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Neumonía Neumocócica/diagnóstico por imagen , Radiografía , Estenosis Traqueal/diagnóstico por imagen , Divertículo de Zenker/diagnóstico por imagenAsunto(s)
Enfermedad de Hodgkin/patología , Neoplasias Pulmonares/secundario , Pulmón/patología , Adulto , Enfermedad de Hodgkin/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , RadiografíaRESUMEN
OBJECTIVES: We present a modified wedge resection of the bronchus, as an alternative bronchoplastic technique for lung resection, in cases of patients with or without adequate pulmonary reserve to undergo a pneumonectomy, in order to preserve lung tissue. METHODS: Seventeen patients underwent a major lung resection with wedge resection of the bronchus for non-small cell lung cancer (NSCLC) in our department, from March 1995 to October 1999. A right-sided NSCLC were diagnosed in 17 males, with a mean age 62.5+/-6.6 (range 51-72) years. Further workup was free of metastatic disease. All patients underwent a right posterolateral thoracotomy, under general anesthesia with a double lumen endotracheal tube. Twelve right upper lobectomies, four right upper and middle lobectomies and one carinal resection were performed. The wedge resection of the bronchus carried out longitudinally, along the bronchial tree, and the bronchial defect was reapproximated transversely, in a single-layer, with interrupted non-absorbable suture. The frozen section of the distal margin of the resected bronchus was negative for malignancy in all patients. Extended mediastinal lymph node dissection followed each lung resection. RESULTS: The pathology report showed 12 squamous-cell carcinomas, three adenocarcinomas, one adenosquamous carcinoma and one neuroendocrine carcinoma. The differentiation of the carcinomas was well in two cases, moderate in ten and poor in five. The pTNM stage was IB in four patients (23.5%), IIA in one (5.9%), IIB in eight (47.1%) and IIIA in four (23.5%). The median disease-free distal margin of the bronchus was 5 mm (range 2-15 mm). The average postoperative hospital stay was 15 days (range 12-28 days). The morbidity and mortality rate was 11.8 and 5.9%, respectively. Postoperative follow-up was every 6 months. The average survival is 20.0+/-15.2 months (range 1-54 months). There are 12 patients alive, and their follow-up is negative for locoregional recurrence or distant metastasis. The survival study showed no significantly statistic relation to the histologic type, cancer differentiation, pTNM stage, and disease-free distal margin of resection larger or less than 0.5 cm (Kaplan-Meier study log rank method). CONCLUSIONS: The wedge resection of the bronchus as a bronchoplastic procedure is an easy, fast and safe technique of reparation of the bronchial tree. It presents not only a low rate of morbidity and mortality, but also a satisfactory survival.
Asunto(s)
Bronquios/cirugía , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Escisión del Ganglio Linfático/métodos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tasa de SupervivenciaRESUMEN
OBJECTIVE: In the staging of lung cancer, pleural effusion that is malignant on cytologic examination is regarded as T4 disease, and curative resection cannot be performed. We conducted this study to determine whether cancer cells can be present in the pleural cavity with no pleural effusion, to investigate the factors contributing to that occurrence, and to evaluate its prognostic significance. METHODS: Eighty-five patients (77 males, eight females) with a median age 60.1-+/--7.9 years (31--74 years) underwent a major lung resection, due to lung cancer in our department. From January 1998 to December 1999, 30 pneumonectomies, seven bilobectomies, 46 lobectomies and two wedge-resections were performed. Chest wall resection was performed in four patients. After performing a posterolateral thoracotomy and lung resection with extended mediastinal lymph node dissection, the pleural cavity was filled with 1 l physiologic saline solution (PSS) and the fluid was shaken. The lavage fluid was suctioned off (S1). Immediately after the lavage, the pleural cavity was refilled with 3 l PSS. The surgeon washed out the pleural cavity by hand for 1 min and the fluid was suctioned off. Finally, the pleural cavity was refilled with 1 l PSS and a new lavage fluid was suctioned off (S2). A cytologic examination was carried out for each sample. RESULTS: The pathology report showed 39 adenocarcinomas, 33 squamous-cell, two adenosquamous, four large-cell, two neuroendocrine and five undifferentiated carcinomas. S1 was positive in eight patients (9.4%), while S2 was positive in four patients (4.7%). The correlation of positive pleural lavage and infiltrated lymph nodes demonstrated a statistically significant relation between presence of N2 disease and positive S2 sample (P = 0.049). No significant correlation existed between positive lavage sample (S1 or S2) and TNM stage, level of T, extent of tumor invasion, kind of operation, histological type or differentiation of the cancer (Chi square test). The mean follow-up is 11.3 +/- 6.2 months (4--22 months). There are 78 patients alive. A significance difference in survival was identified in-patients with positive S1 (P = 0.0081), and positive S2 (P = 0.0251) (Kaplan--Meier). CONCLUSION: The cytologic results of lavage were positive for malignant cells in eight of 85 patients (9.4%). The existence of cancer cells in the pleural cavity can be the result of their exfoliation or surgical manipulations. The mechanical irrigation subdivides the percentage of positive samples. Our study supports that the positive findings on pleural lavage cytology is an essential prognostic factor.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Pulmonares/cirugía , Pleura/citología , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Pleura/patología , Neumonectomía , Pronóstico , Análisis de Supervivencia , Irrigación TerapéuticaRESUMEN
Patients with hyporeninemic hypoaldosteronism show mild to moderate renal insufficiency, with a creatinine clearance of 20-75 ml/min, and asymptomatic hyperkalemia. A low degree of sodium wasting and mild hyperchloremic metabolic acidosis are also usually present. However, severe sodium wasting and volume depletion are not typically seen unless the patient is placed on severe sodium restriction or has some other cause of extrarenal sodium loss. In fact, acute renal failure has not been reported in such patients. We describe a diabetic patient with hyporeninemic hypoaldosteronism and autonomic neuropathy who developed recurrent episodes of acute renal failure due to prerenal azotemia during acute exacerbations of diarrhoea. In our case, despite significant hypovolemia, the renin-aldosterone axis was markedly suppressed, implying that sympathetic tone played a decisive role in renin regulation.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Neuropatías Diabéticas/complicaciones , Diarrea/complicaciones , Hipoaldosteronismo/etiología , Uremia/etiología , Anciano , Humanos , MasculinoRESUMEN
A patient with extreme essential thrombocytosis who exhibited an array of real or spurious metabolic abnormalities is described. Careful venipuncture and prompt measurement avoided unnecessary further laboratory investigation and potentially dangerous overtreatment.
RESUMEN
BACKGROUND: A case-control study exploring the role of smoking and outdoor air pollution in the causation of lung cancer, by histologic type, in nonsmoking women, was undertaken in Athens between 1987 and 1989. METHODS: One hundred one women with lung cancer and 89 comparison women with fractures or other orthopedic conditions, all permanent residents of Greater Athens, were included in the study. Smoking habits were ascertained through interviews, whereas lifetime exposure to air pollution was assessed by linking blindly lifelong residential and employment addresses of all subjects with objectively estimated or presumed air pollution levels. RESULTS: The age-adjusted relative risk and 95% confidence intervals for lung cancer among current smokers compared with nonsmokers was 3.40 (1.75-6.61); it was 7.43 (2.88-19.13) among those smoking for more than 30 years and 7.46 (2.40-23.17) among those smoking more than 20 cigarettes per day. The age-adjusted relative risk was 1.70 (0.75-3.89) for adenocarcinoma and 6.45 (2.73-15.25) for other histologic types of lung cancer; statistically significant dose-response trends were evident for both histologic groups. Air pollution levels were associated with increased risk for lung cancer but the relative risk was small and statistically not significant. However, when both air pollution and duration (or quantity) of tobacco smoking, as well as their interaction, were introduced in a multiple logistic regression model, the interaction term was significant at the suggestive level of 0.10. CONCLUSION: Whereas there is no effect of air pollution among nonsmokers, the relative risk contrasting extreme quartiles of air pollution among smokers of 30 years duration was 2.23. The interaction was almost exclusively accounted for by the nonadenocarcinoma lung tumors.