Video-assisted thoracoscopic pleurodesis for malignant pleural effusions.

AIM: The objective was to analyse the efficiency, and safety of thoracoscopic pleurodesis (TP). A retrospective study was made of an initial series of 75 patients undergoing lifetime follow-up who received TP in our department for the treatment of malignant pleural effusions (MPE). MATERIAL AND METHODS: From May 1994 to December 1998, 34 men and 41 women with a median age of 63.4 +/- 12.5 years were treated by TP. We performed 36 partial diathermic abrasions on pleura combined with talc insufflation, and in 39 cases only talc poudrage. The mean duration of insention of the chest tube was 4.1 (range 2 to 17) days, with 8.4 (range 5 to 20) days of postoperative hospitalization. There were no severe intraoperative or postoperative complications. The 30-day mortality rate was 1.3% (1 case). The period of follow-up ranged from 2.5 to 40 months (average 6.8). No case of late recurrence has been observed to date. CONCLUSION: Videothoracoscopic pleurodesis (talc poudrage) as a simple and efficient procedure seems to be the best alternative treatment regimen for the management of MPE in a group of selected patients.

The value of Asamura-Naruke type main bronchus stump closure and pleuro-pericardial flap covering by own method to avoid broncho-pleural fistula (BPF).

1. Authors present an "old-new" main bronchus closure procedure, which combines the Sweet's and Overholt's methods, recommended by Asamura-Naruke. 2. The A-N procedure decreased the prevalence of BPF from 2.8% to 0.09% in case of thoracotomy and from 9.5% to 2.4% in case of pneumonectomy compared 2 different stump-closing types. 3. There was not BPF in the "covered subgroup" (0%/92 PN) recommended by us, independent of the closing types. 4. All bronchial stumps closed like A-N and covered by our method (0% BPF/62 PN) healed.

[Central bronchoplastic procedures in Hungary and their outcome (198-1993)]. / Centrális hörgöplasztikai megoldások és eredményeik Magyarországon (1980-1993).

Bronchoplastic procedures involving the main carina are declared as central bronchoplasties. A nation-wide collection of these interventions performed between 1980 and 1993 is analysed. The study is on a total of 154 operations, that were 16 bifurcation resections and 14 stem bronchus resections without parenchyma sacrifice, 61 sleeve or wedge pneumonectomies and 63 tracheal sleeve or wedge right upper lobectomies or carina-plasties. Surgery alone-without multimodality therapy-was the choice of treatment almost exclusively. About 90% of these interventions were performed for highly malignant, histologically peripheral-type, but centrally located bronchial cancers. The hospital mortality and morbidity were found up to 30% (an average of appr. 17%), depending on surgical subsets. Cause of death were surgical at 11% (leakage, anastomotic dehiscence and bleeding) and non surgical at 5.8% respectively. Complications at another 9% were related to surgery. Data of survival suggest, that nodal state is the strongest predictor, but the unfavourable N2 group comprises longer survivors as well. Certain part of this kind of interventions is to be chosen without alternatives (isolated tracheobronchial resections without parenchyma-resection, extended pneumonectomies) while extended lobectomies are alternatives of the extended pneumonectomies in strict conditions. A central bronchoplastic procedure is justified only with hope of complete resection for its high complication rate.

["Busulfan lung" simulating tumor]. / Tumort utánzó "busulfan tüdö".

The authors present a case in which a patient, treated with Myleran for chronic myeloid leukaemia showed tumour like changes in the lung. They stress the differential diagnostic difficulties and the importance of histological diagnosis. This case proves that with discontinuation of the therapy the lung change may be reversible.

[Primary (B-cell) mediastinal lymphoma]. / Primer (B-sejtes) mediastinalis lymphoma.

The authors present two cases of a new pathological entity--primary (B-cell) mediastinal lymphoma. The disease both clinically and histologically differ from the known lymphomas. Its diagnosis is possible only with the use of immunhistochemical methods. The low age incidence, the unusual course and the bad prognosis of the disease merits its publication.

[Lymphoproliferative lung lesions (pseudolymphoma--malignant lymphoma]. / Lymphoproliferativ tüdölaesiók (pseudolymphoma--malignus lymphoma).

The authors report on the cases of five patients who suffered from primary pulmonary lymphoproliferative disease. Of 4 pseudolymphoma cases 3 were free of symptoms and complaints. One patient was operated on 14 years earlier and suffered also from associated Sjögren's syndrome. In this case the monoclonal immune globulin containing cell groups found earlier in the lymph node referred to the possibility of chronic dysproteinemia and to the transformation into malignant lymphoma of the hepato-splenomegaly. The contralateral pulmonary recurrence following the lung resection of a patient with malignant lymphoma was successfully treated with telecobalt irradiation. In connection with the literature and their cases the authors discuss the problems of differential diagnostics, therapy and prognosis as well.

Effect of aeration on cortisol and androgen output by pig adrenal homogenate.

Of the steroids produced by pig adrenal homogenate, the output of cortisol+11-deoxycortisol, corticosterone, 11 beta-hydroxyandrostenedione, and the steroid intermediates: pregnenolone, 17 alpha-hydroxypregnenolone, progesterone, 17 alpha-hydroxyprogesterone were analysed. The incubations were carried out with and without aeration. Without aeration the oxygen tension in assay medium decreased during incubation in spite of constant shaking. However, it remained constant (140 Hgmm) with aeration throughout the incubation (60 min). The results of steroid analysis demonstrated that the output of 11 beta-hydroxyandrostenedione decreased strongly, and that of cortisol slightly without aeration, however, the output of corticosterone did not change. The addition of 17 alpha-hydroxypregnenolone or 17 alpha-hydroxyprogesterone to the incubation medium eliminated the decrease in the output of cortisol, but not that of 11 beta-hydroxyandrostenedione. The observations suggest that the activation of oxygen in the enzyme reaction catalyzed by 17, 20-lyase, and perhaps by 17 alpha-hydroxylase is weaker than the activation mediated by 21-hydroxylase and 11 beta-hydroxylase.

Steroid spectrum in human urine as revealed by gas chromatography. VI. Pregnanediol excretion values and 3 beta-hydroxy-delta 5-steroid dehydrogenase activity of girls at different stage of development.

Pregnanediol excretion in the urine of girls aged 2-14 years was found to be 0.13 +/- 0.17 mg/day. Before puberty the amount of pregnanediol excreted was low but a marked increase could be observed during puberty. In the case of premenarchal girls this increase correlated well with increasing body weight, while in the presence of cycle ovarian function (anovulational cycles) it exceeded the expected level. The activity of 3 beta-hydroxy-delta 5-steroid dehydrogenase was assayed in vivo indirectly, by measuring pregnanediol (pregnanediol and androsterone + ethiocholanone) DHA ratios from urine. A composition of the two ratios indicated that the utilization of the endogenous C21 intermediate was one order of magnitude less than that of the C19 intermediate. To interprete this finding it is assumed that the delta 5-3 beta-HSD of the liver is on allotype of the adrenal enzyme with a reduced activity, towards the C21 intermediate. The biological significance of this presumption is also discussed.

Tracheal substitution in dogs with reinforced Gore-Tex prosthesis.

Reinforced Gore-Tex prostheses were implanted into the trachea, above the bifurcation, in 11 dogs. The first 3 animals died within a few days, due to an inappropriate surgical technique. The remaining animals were subjected to an adequate surgical procedure and all survived for a period of at least several months, except one which died of an esophago-tracheal fistula after 6 weeks. Ingrowth of respiratory epithelium into the prostheses was observed 5 to 7 weeks postoperatively.

Dynamics of adrenal steroidogenesis in childhood: changes in the excretion of 16-oxygenated- and 11-oxygenated-steroids by 21-hydroxylase deficient children at various ages.

The close relationship between C19O2 steroid excretion and the ratio of C19O2/C21O5 steroids indicates that it is the elevation of C17,20-lyase activity, which represents the decisive factor in the cessation of androgen-corticoid disproportion during the puberty of healthy children. In 3-6 year-old C21-hydroxylase deficient children treated with corticoids in doses only partially suppressing endogenous ACTH secretion, the excretion of total C19 steroids increased continuously parallel with a well defined elevation of 16 alpha-oxygenated-C21 steroid excretion. The patients did not show the physical signs of adrenarche before six years. This can be attributed to three factors: a) substitutional corticoid therapy; b) intraglandular control of delta 5-pathway by 16 alpha-hydroxylation of C21 steroids; c) neutralisation by 11 beta-hydroxylation of the androgen effect of C19O2 steroids.

Dynamics of adrenal steroidogenesis in childhood: steroid excretion in prepubertal and pubertal girls.

C19-C21O2-3 steroid spectrum and C21O5 corticoids have been studied in the urine collected from 29 girls aged 2-14 years. A total of 34 investigations was carried out by means of simultaneous two-column gas chromatography. The values of steroid excretion have been expressed in terms related to body weight and body surface, respectively. Before the age of seven the excretion of C19O2 steroids representing adrenal androgens and their metabolites did not exceed 7 micrograms/kg/day or 170 micrograms/m2/day ("infantile type androgen excretion"). Then it began to increase between the 7th and 9th years of life and preceded the appearance of the physical signs of adrenarche. The increase was accelerated during puberty and no value under 18 micrograms/kg/day, or 600 micrograms/m2/day, respectively, was found when the physical signs of adrenarche were present ("puberty type androgen excretion"). Excretion of 11-oxygenated C19 steroids, C21O5 corticoids and pregnenediol was also augmented during puberty; however, when compared with the increase in C19O2 excretion this augmentation was moderate. As a consequence of the marked elevation in C19O2 excretion, the ratio of C19O2 to C21O5, too, increased during puberty, indicating that the cortisol-androgen dissociation, otherwise characteristic of childhood, had ceased. It is concluded that the most plausible explanation of the increased androgen production is the gradual development of the zona reticularis during puberty.

Steroid spectrum in human urine as revealed by gas chromatography V. Identification and quantitation of 3 alpha, 20 alpha-dihydroxy-5-beta pregnan-11-one (11-keto-pregnanediol) during different stages of development in children with C/21 hydroxylase deficiency.

A component was observed in the steroid spectrum of the urine of salt-loosing children with C/21-hydroxylase deficiency, which was eluted from Sp 2100 stationary phase before pregnanetriol but, unlike pregnanetriol, exhibited heat and acid stability. This component was isolated by paper chromatography and identified as 3 alpha, 20 alpha-dihydroxy-5 beta-pregnan-11-one by GC-MS and further gas chromatographic analysis. The amount of the steroid was minimal in the urine of infants, while in children submitted to substitution corticoid therapy it showed an increasing tendency, especially during puberty. The maximal value of excretion, in one case, amounted to 17% relative to total steroids. In puberty a significant excretion of 11-keto-pregnanediol indicates that under the given conditions the 11 beta-hydroxylation of steroid intermediates in the adrenals may be considerable not only at the level of 11-hydroxy-progesterone but also at that of progesterone.

Pulmonary and systemic circulatory responses elicited by hyperosmotic solutions injected into the bronchial artery.

In open chest anaesthetized dogs the haemodynamic effects of solutions of equal hyperosmolarity (viz. NaHCO3 8%, NaCl k.6%, and glucose 34.3%, solutions) given into the bronchial artery were studied. Administration of any of these solutions directly into the bronchial artery resulted in increased cardiac output, stroke volume, bronchial blood flow, and bronchial fraction of the cardiac output, and decreased heart rate and bronchial as well as pulmonary vascular resistances. When given into the pulmonary circulation, the same solutions evoked similar reactions of smaller magnitude. To exclude the effect of major surgical trauma and the open-chest condition, another experimental model closer to the physiological situation was also developed. In this preparation NaHCO3 failed to produce the above haemodynamic response even when given into the bronchial artery. After a one-hour bleeding period resulting in a drop of arterial blood pressure to 40 mmHg, while using the same preparation, the administration f NaHCO3 solution into the bronchial artery caused a significant rise in blood pressure in both the systemic and pulmonary arteries. In these experiments a correlation was found between arterial oxygen tension and the extent of change in blood pressure. The exact mechanism of action of the observed haemodynamic changes is still not clear. However, it is likely that receptors localized in the area of the bronchial circulation and sensitive to hypoxia might have played a role in the development of the haemodynamic effects described.

Steroid spectrum in human urine as revealed by gas chromatography. III. Identification and quantitation of pregnenediol at different stages of bodily development.

Gas chromatographic analysis of steroids using Sp-2100 stationary phase revealed that all urine samples from 34 healthy children (aged 4-14 years) and from 35 adults contained 5-pregnene-3 beta, 20 alpha-diol, which was also identified by GC-MS. The extent of pregnenediol excretion continuously increased from prepuberty to adult age. The observed increase in pregnenediol excretion during prepuberty points to an enhanced biosynthetic activity of the adrenal gland in the years preceding sexual maturation.