Alpha-1-antitrypsin (AAT) deposits in gall bladder adenocarcinoma and liver in partial AAT deficiency (Pi SZ phenotype).

Alpha-1-antitrypsin (AAT) immunoreactive inclusions were found in an adenocarcinoma of a gall bladder of a patient with Pi SZ phenotype who also had globular AAT accumulation in the liver. The inclusions did not react with antibodies against other plasma proteins, thus suggesting a primary synthesis of AAT in these cells. The presence of AAT in the tumor cells may represent resurgence of an oncofetal antigen, or, indirectly, may mean that AAT-containing cells normally exist in the human non-neoplastic gall bladder. The accumulation of AAT in tumor cells might be a basic process in malignant transformation.

[Bronchiolo-alveolar cell carcinoma]. / Das Bronchioloalveolarzellkarzinom.

15 cases of bronchiolo-alveolar cell carcinoma were observed at the Dept. of Surgery of the University Hospital of Zurich from 1961 to 1976. The mean age of these patients was 56 years. The sex distribution was 13 males and 2 females. Five cases were discovered accidentally; the symptoms of the remaining 10 were uncharacteristic. Cytology, bronchoscopy and mediastinoscopy were negative at early stages. Diagnosis was made by histologic examination of the specimens only. Needle biopsy, performed routinely over recent years, proved helpful in 4 cases. In 12 out of 14 patients, lobectomy was considered 'radical'; nevertheless, only 2 survived more than 5 years. The disseminated form of the bronchiolo-alveolar cell carcinoma is characterized by a particularly poor prognosis. According to our experience and to the literature, only the solitary, nodular type shows a more favourable outlook.

[Therapy of pleural empyema after pneumonectomy with open-window drainage and continuous rinsing]. / Die Therapie des Pleuraempyems nach Pneumonektomie durch Thoraxfensterung bzw. kontinuierliche Spülung.

From 1961 to 1977 24 thoracic empyemas (=4,75%) after 507 pneumonectomies were observed at the Surgical Clinic A of the Zurich University Hospital. Two methods for the management of this condition are discussed: open-window drainage (CLAGETT) and continuous rinsing of the pleural cavity (LUIZY). The first mentioned method proved to be a palliative one in our patients: no thoracostomy could be re-closed operatively. Two thoracic windows healed up spontaneously without recurrence of an empyema; one patient died shortly after the operation from respiratory insufficiency. Of the five patients treated by continuous rinsing, four were cured as for their empyema, but one of the latter died from renal insufficiency. In one case an open-window drainage finally had to be accomplished.

[Results and complications of bronchoplastic operations for bronchial cancer (author's transl)]. / Résultats et complications des opérations bronchoplastiques pour cancer bronchique.

Among 1548 patients hospitalized from 1964 to 1975 for bronchial carcinoma, 779 underwent a brochopulmonary resection. Seventeen patients underwent bronchoplastic resections. The average hospital stay was 45 days which is explained by the frequency of postoperative complications (n = 8). The mortality during hospitalization was 11.5% and the 5 year survival rate was 18%. The survival curved was comparable to that of the patients who underwent a lobectomy or simple or enlarged radical pneumectomy. Actually, the average survival is 26 months and the comfort in these cases is impressive. We consider that the indication for these plastic resections should be extended to patients who are capable of tolerating a pneumectomy.

Surgery of differentiated thyroid adenocarcinomas. / Chirurgie des adénocarcinomes thyroïdiens différenciés.

The authors present a retrospective study of 110 patients operated for adenocarcinoma of the thyroid between 1950 and 1975, and submitted to standard postoperative radiotherapy. Clinical manifestations are poor and preoperative scintigraphy display a cold tumor in 80 percent of those performed. The preoperative cytodiagnosis confirms malignancy in 90 percent of cases approximately, thereby reducing the number of complementary reoperations. In the latter the rate of complications. Increases from 25 percent to 44 percent. Three are twice as many recurrent nerve palsies and parathyroid resections in total thyroidectomies as compared to subtotal. However after radical resection local recurrences and metastases are 4 times less frequent. Under combined radio-surgical treatment 82 percent of patients are alive with a mean survival time of 9.4 years; 9 percent have died of their disease after a mean 4.1 years and 9 percent have died of an unrelated condition an average 7.2 years after. The authors favor total or near-total, i.e. extracapsular homolateral and intracapsular controlateral, thyroidectomy for follicular and papillar adenocarcinomas alike, followed by local radiotherapy and destruction by 131 iodine (Acta chir. belg., 1977,76, 553-561).

[Bronchoplastic methods in the resection treatment of malignant bronchial tumors]. / Bronchoplastische Verfahren in der Resektionsbehandlung maligner Bronchialtumoren.

1548 patients who were hospitalized 1964--1975 for diagnosis and treatment of bronchogenic carcinoma, 779 underwent resection. 17 patients could be operated by lobectomy or bilobectomy and bronchial resection (sleeve resection). Postoperative complications were frequent (n = 8): 4 times bronchopleural fistula, 2 times empyema, once fatal pneumonia and once bronchial stenosis. The overalll mortality and the survival rates are comparable to those of patients with radical resections. Sleeve resection is therefore a suitable alternative to pneumonectomy in elderly patients with reduced pulmonary function, rarely indicated also by a favourable tumor size. Sleeve resection increases the resectability of malignant bronchogenic tumors by 2%. Methods to prevent or cure the postoperative complications consisted in the use of absorbable suture material and long lasting intrathoracic suction.

[Treatment of spontaneous pneumothorax and prophylaxis of relapses (author's transl)]. / Traitement du pneumothorax spontané et prophylaxie des récidives

This study reports the treatment of 192 consecutive cases of spontaneous pneumothorax observed in 99 patients. Relapses are frequent, but it could be shown that their number can be reduced by more aggressive therapy. Conservative treatment led to 99 % of relapses, whereas they were reduced to 32 % by continuous pleural suction, as shown in 76 cases. Pleurodesis with glucose 40 % or 50 % solution followed by continuous suction for 7 days, is advertised by the authors for every first episode of spontaneous pneumothorax. Under this treatment relapses were observed in only 19 % of the cases. If however after this treatment a recurrent pneumothorax occurs, thoracotomy has to be considered for parietal pleurectomy and occasional resection of emphysematous bullae. This procedure was successfull in all 13 cases where it had been applied.