Survival of patients with resected pIIIa - N2 non small cell lung cancer: suggestion for subclassification.

PURPOSE: The group of completely resected stage IIIa- N2 non small cell lung cancer (NSCLC) patients is considered heterogeneous in various aspects including survival and pattern of recurrence. The prognostic factors still remain controversial. Clinical trials dealing with multimodal strategy for N2 NSCLC are being watched with keen interest, and the feasibility of this strategy is to be confirmed. In the present study we attempted to clarify the role of different clinicopathological factors which separate patients into high and low- risk groups based on the disease-free and overall survival. PATIENTS AND METHODS: The study comprised 60 consecutive patients with pathologically (p) proven N2 NSCLC who had undergone complete surgical disease resection with curative intent between January 1997 and September 2000. All patients had an apparently resectable disease at preoperative staging and thoracotomy. Extensive mediastinal lymph node dissection was performed when possible and consisted of removal of all ipsilateral mediastinal lymph nodes. Patients were submitted to postoperative split course adjuvant radiotherapy. Cumulative survival rates were calculated by the Kaplan-Meier method. The analyzed prog- nostic factors were age, histological type and grade of differentiation, clinical (c) stage, cN status and tumor size and were tested for statistical significance by univariate analysis using log-rank test and Willcoxon test. RESULTS: The median follow-up period was 36 months (range 24-72 months). Tumor size, cN status and age were significant predictors of survival. Large tumor size (T3) was significantly worse predictor compared to T1 (p=0.046) and cN2 status evaluated by computed tomography (CT= also showed statistically significant unfavorable prognosis in comparison with cN0 and cN1 (p=0.0185). Patients over 65 years had significantly worse prognosis compared to those under 65 years (p=0.008). CONCLUSION: This study identified stage IIIa - N2 NSCLC prognostic subgroups and suggests different therapeutic approach according to the subgroup profile.

[Traumatic rupture of the left hemidiaphragm]. / Traumatska ruptura leve hemidijafragme.

A case of blunt traumatic rupture of the left hemidiaphragm following a traffic accident was presented. On admission the patient complained of a dyspnoea, and the physical examination of the thorax revealed the absence of breathing sound on the left side. A chest radiography and CT scan had shown the presence of the stomach in the left hemithorax. Posterolateral thoracotomy was performed. In the opened hemithorax, the stomach, omentum and small bowel were found to having passed undamaged through a 12 cm tear of the central part of the diaphragm. These abdominal viscera were replaced in the abdomen and the diaphragm was sutured.

[Resection of post-intubation tracheal stenosis]. / Resekcija postintubacijskestenoze vratnog dela traheje.

The management of a patient with post-intubation circumferential stenosis and tracheostomy was presented. Tracheal resection and reconstruction were performed. The length of resection was four centimeters. The tracheostomy was included in the resected part. The problems of tracheal dissection and mobilization and approximation of the tracheal ends due to the anastomosis were presented. The possibilities of the intubation and adequate ventilation across the operative field were shown.

[Staphylococcal pneumonia associated with pneumatoceles, bilateral pyopneumothorax and sepsis]. / Stafilokokna pneumonija pracenja pneumatocelama, obostranim piopneumotoraksom i sepsom.

A case of soldier with community acquired staphylococcal pneumonia and multiple pneumatoceles as the rare complication in adults is presented. Their recognition provides appropriate treatment. In the patient were developed bilateral pneumothorax, pleural empyema and sepsis. Surgical treatment was performed by thoracic drainage. Recovery of pulmonary function was poor, as distinguished from children.

Behavioral and immunological events induced by electrical stimulation of the rat midbrain periaqueductal gray region.

We report here on the immunological and behavioral alterations induced by stimulation of the mesencephalic periaqueductal gray matter (PAG), a component of the brain aversive system. Male Wistar rats were implanted with stimulating electrodes in the caudal dorsolateral part of the PAG. After recovery, animals were screened for aversive behavior, characterized by running, jumping, vocalization or freezing reaction. Then, rats were subdivided to those which could control aversive stimulation (AS) by switch-off response (cAS group) and those which could not interrupt AS (uAS group). After sensitization with bovine serum albumin (BSA) in complete Freund's adjuvant, rats were stimulated 3 times/week for 40 days, each session lasting 30 min/rat. Immunological assessment included antibody production and hypersensitivity skin reactions to BSA 14 and 21 days after immunization. A behavioral profile of aversively stimulated animals was determined by a poststartle response, open field (OF) activity and two-way shuttle-box avoidance task. The results revealed elevated antibody production to BSA in cAS and lowered in uAS rats, compared to sham-stimulated and intact controls. Arthus and delayed hypersensitivity skin reactions increased in PAG-stimulated animals on day 14 but not on day 21 after immunization. Poststartle response was enhanced both in cAS and uAS rats. Along with immunopotentiation, administration of cAS produced hyperactivity in OF test and facilitation of the active avoidance learning, whereas uAS caused only moderate suppression of rearing in a novel OF environment. Physiological implications and possible mechanisms that may account for PAG-mediated immunobehavioral changes are outlined.

[Hemangiopericytoma of the lungs]. / Hemangiopericitom pluca.

Six patients, three women and 3 men with lung hemangiopericytoma treated at the Military Medical Academy in the period 1971-1991 are reported. The youngest patient was 20 years, the oldest 69 years. Surgical treatment was performed in all patients, 3 lobectomies, one bilobectomy, one wedge resection and one extirpation. Multiple hemangiopericytoma was found in one patient which consisted of three separate tumours in the right lung. The other had solitary lesions. Malignant hemangiopericytoma, was found in 4 patients, one of them had metastases in the mediastinal lymphatic glands. Four patients are alive and are under control for nine years in the average without signs of recurrence.

[Decortication of the lung in the treatment of nonspecific pleural empyema]. / Dekortikacija pluca u lecenju nespecificnih empijema pleure.

In the period 1986-1990 at the Clinic of Cardiac and Thoracic Surgery 86 patients with nonspecific pleural empyema were treated. There were 18 men and one woman, mean age of 35.6 years. Causes of empyema have been the following: pleuropneumonia (10 patients), chest trauma (2), iatrogenic pleural infection (2), spontaneous pneumothorax (2), mediastinitis (1) and pleural infection per continuitatem (2). The authors consider that decortication should be performed as early as possible, immediately after stabilization of acute signs of infection. The optimal time for surgery is from to six hours since the onset of the disease.

[Exposure to selenium in photocopying workers]. / Ispitivanje izlozenosti selenu radnika u fotokopirnicama.

The selen concentration was found in the air of 10 photocopy rooms with the mean value of 0.0025 +/- 0.0013 mg Se/m3 of the air which markedly below the maximally permissible concentration. In the same time selen was determined in serum and urine of persons in these photocopy rooms and in 22 control subjects. The mean value of selen in urine of workers in photocopy rooms was 76.50 +/- 12.60 micrograms Se/1, which is statistically significant compared with the control group which indicate that workers are exposed to selen but in a smaller degree. In the exposed subjects selen urine concentrations were higher compared to the control group with the mean value of 19.01 +/- 6.79 micrograms Se/1, but it has not been statistically significant. The selen level in urine and serum of examinees were mainly in the limits given for normal population so that the present selen exposure of workers in the photocopy rooms could not be considered harmful for human health.

[Mechanical sutures in the management of the stump of the main bronchus]. / Mehanicki sav u zbrinjavanju patrljka glavnog bronha.

In the period 1964-1988 there have been performed 3173 pulmonary resections of which 1261 pneumoectomies. In 952 patients the mechanical suture was placed in the main bronch and standard suture in 309 patients. For mechanical sutures the Soviet UKL-40 or 60 apparatus was used. The bronchial fistula occurred in 9.2% of surgical patients after using mechanical suture and in 36.5% after using standard suture.