Determination of In Vivo efficacy and safety of zeolite as a new pleurodesis agent.

Pleural effusion, the pathological condition in which an abnormal amount of pleural fluid is accumulated in the small space between the visceral and parietal pleurae of the lungs, can be treated by pleurodesis, whereby the pleural space is obliterated. This effect can be achieved by chemical pleurodesis utilizing various reagents such as talc, an agent commonly employed in pleurodesis. Zeolites, microporous tectosilicates found in nature as minerals, can be used in a wide range of medical applications. Different zeolite compounds may exhibit variable efficacy and safety profiles, mainly depending on their particle size. In this study, we evaluated the efficacy and safety of zeolite pleurodesis. New Zealand rabbits were administered 400 mg/kg of either agent dissolved in 2 mL of isotonic saline solution by injection into their pleural cavity, and computed tomography images were obtained on postoperative day 26. Euthanization was conducted at the end of 28 days for histopathological evaluation. Furthermore, subacute toxicity and mutagenicity profiles of zeolite were analyzed. Our findings revealed that zeolite was able to induce an adequate inflammatory response to achieve successful pleurodesis. The adhesion profiles were in favor of zeolite when compared to talc pleurodesis. Moreover, none of the tested doses of zeolite induced subacute toxicity or mutagenesis. Collectively, our results suggested zeolite as an effective and safe pleurodesis agent.

Investigation of Caspase 9 Gene Polymorphism in Patients With Non-small Cell Lung Cancer.

BACKGROUND/AIM: Non-small cell lung cancer (NSCLC) is one of the most common forms of lung cancer and the leading cause of cancer-related deaths in the world. Caspase 9 (CASP9) plays a central role in the intrinsic apoptotic pathway. The aim of the study was to investigate the role of caspase 9 gene polymorphism in patients with non-small cell lung cancer. MATERIALS AND METHODS: The study included 96 NSCLC cases and 67 controls. CASP9 Ex5+32 G>A polymorphism was investigated by real-time polymerase chain reaction. RESULTS: There was a significant difference between the groups in the frequency of CASP9 genotypes (p=0.008). The number of the carriers of the ancestral GG genotype, was significantly higher in the NSCLC group than in the control (p=0.009). The heterozygote GA genotype and mutant A allele frequency were significantly higher in the control group compared to the NSCLC group (p=0.005, p=0.009, respectively). Serum CASP9 levels were significantly lower in the patients group than in the control group (p<0.0001). CONCLUSION: CASP9 Ex5+32 GG genotype was a risk factor whereas the variant A allele could be a risk-reducing factor for NSCLC.

Unicentric mixed variant Castleman disease associated with Hashimoto disease: the role of PET/CT in staging and evaluating response to the treatment.

Castleman disease (CD) is a rare atypical lymphoproliferative disease, pathologically classified as hyaline vascular, plasma cell type and mixed type variant. The underlying cause of CD is unknown, however several theories including autoimmunity have been proposed. We describe a patient diagnosed with unicentric mixed variant CD and Hashimoto thyroiditis, concurrently. She was staged with fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) and the disease was localized to the mediastinum. After 6 cycles of chemotherapy consisting of vincristine and prednisone, the mediastinal lymph nodes regressed, but did not disappear from the CT scan. However, FDG-PET/CT showed complete metabolic response. Although the role of FDG-PET/CT in staging and evaluation of treatment response is controversial, this case shows that PET/CT can be effective and even better for staging and response evaluation. This case is also unique as there no case of CD in association with Hashimoto thyroiditis has been reported previously. However, the possibility of a coincidental association must be raised, especially when the high prevalence of Hashimoto thyroiditis is considered.

Surgical treatment of a bronchial cyst causing compression to the left atrium and pulmonary artery.

Bronchogenic cysts that formed during the development of the tracheobronchial tree in the gestational period are mostly asymptomatic until adulthood. Cysts localized in the middle mediastinum, specifically in the subcarinal region, on the other hand, may cause serious symptoms by compressing the heart and major vessels due to their close proximity. In this report it is suggested that surgical resection of a giant bronchogenic cyst that compresses the heart and great vessels should be securely performed in the presence of a readily available cardiopulmonary bypass capability.

Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer?

OBJECTIVE: We sought to compare the outcome of patients with esophageal cancer who had either modified Collard or standard hand-sewn cervical esophagogastric anastomoses in reconstruction during esophagectomy. METHODS: From March of 1996 to October of 2002, 274 patients with esophageal cancer underwent esophagectomy with gastric replacement and cervical esophagogastric anastomosis. Beginning in March of 2001, a modified Collard technique (stapled) was used in most patients (n = 86) for cervical esophagogastric anastomosis; a standard hand-sewn technique (sewn) was used in all others (n = 188). Using a propensity score based on 8 variables (age, gender, race, surgeon, surgical approach, pathologic stage, histologic cell type, and induction chemoradiotherapy), 85 patient pairs were matched and followed for time-related events. Outcome comparisons included cervical wound infection, cervical anastomotic leak, other hospital complications, length of stay, anastomotic dilatation, reflux symptoms, and survival. RESULTS: At 30 days, freedom from cervical wound infection was 92% for stapled versus 71% for sewn anastomoses ( P = .001), and freedom from cervical anastomotic leak was 96% versus 89% ( P = .09), respectively. Other hospital complications occurred in 58% and 49%, respectively ( P = .17). Median length of stay was 10 days for both ( P = .3). At 2 years, freedom from anastomotic dilatation was 34% for stapled versus 10% for sewn anastomoses ( P < .0001), and the mean number of dilatations per patient was 2.4 versus 4.1 ( P = .0001), respectively. Reflux was rare for both. Thirty-day, 6-month, and 24-month survivals were 98%, 91%, and 77% for stapled anastomoses and 98%, 88%, and 69% for sewn anastomoses ( P = .3). CONCLUSIONS: The modified Collard anastomotic technique dramatically reduces morbidity after esophagectomy. It should replace hand-sewn esophagogastric anastomoses.

Prognostic significance of lymph node metastasis found during pulmonary metastasectomy for extrapulmonary carcinoma.

BACKGROUND: The prognostic significance of lymph node metastasis in cancer patients is well documented. Pulmonary metastasectomy in selected patients is associated with improved survival. Little is known about the prognostic significance of lymph node metastases found during pulmonary metastasectomy for extrapulmonary carcinoma metastatic to the lung. METHODS: The records of all patients who underwent pulmonary metastasectomy and complete mediastinal lymph node dissection for extrapulmonary carcinomas at our institution from November 1985 through July 1999 were reviewed. RESULTS: Eight hundred eighty-three patients underwent pulmonary metastasectomy. Of these, 70 patients (7.9%) (44 men, 26 women) had concomitant complete lymphadenectomy. Median age was 64 years (range, 33 to 83 years). Median time interval between primary tumor resection and metastasectomy was 34 months (range, 0 to 188 months). Wedge excision was performed in 46 patients, lobectomy in 16, both in 7, and pneumonectomy in 1. Lymph node metastases were found in 20 patients (28.6%) and were classified as intrapulmonary or hilar (N1) in 9, mediastinal (N2) in 8, and both in 3. There were no operative deaths. Median follow-up was 6.6 years (range, 1.1 to 14.6 years). Three-year survival for patients with negative lymph nodes was 69% as compared with only 38% for those with positive lymph nodes (p < 0.001). CONCLUSIONS: The presence of lymph node metastases at the time of pulmonary metastasectomy for extrapulmonary carcinoma has an adverse effect on prognosis. Complete mediastinal lymph node dissection should be considered at the time of pulmonary metastasectomy for carcinoma to improve staging and guide treatment.