Thoracic empyema: a five-year experience at Queens Hospital Center.

A retrospective analysis of 48 cases of thoracic empyema is presented along with a management protocol, which includes empiric antibiotic therapy or combinations thereof and an aggressive primary surgical procedure that results in minimal morbidity and mortality. In this series, there were eight deaths (16.6%). The contributing etiologic agents, however, have shifted from traditional causes, such as posttonsillectomy, postdental extractions, and bronchiectasis, to stupor caused by excessive alcoholism and drug addiction, also involving direct access through injectables into the cardiovascular system.

Sternotomy infection after harvesting of the internal mammary artery.

Use of the internal mammary artery for coronary revascularization does not increase the incidence of postoperative median sternotomy wound infection. When infection does occur in these patients, however, successful treatment is more likely to require more aggressive surgical manipulation, such as the use of vascularized muscle pedicle grafts, to eventually close the sternal defect.

Spontaneous pneumothorax from bronchogenic carcinoma.

Spontaneous pneumothorax secondary to bronchogenic carcinoma is an unusual occurrence. Reported here is a patient with adenocarcinoma of the lung whose presenting symptom was spontaneous pneumothorax. A brief review of the literature is presented.

Treatment of early cancer of the breast (T1N0M0 and T2N0M0) on the basis of histologic characteristics.

This is a retrospective study of the results of various types of surgical treatment of early breast cancer staged histologically using the following characteristics: (1) poor cytologic differentiation, (2) lymphatic permeation, (3) blood vessel invasion, or (4) invasion of the tumor into the surrounding soft tissue. Four hundred and three patients who had early tumors of the breast--228 T1N0M0 (tumor 2 cm or less in diameter, no nodal involvement, and no metastasis) and 175 T2N0M0 (tumor 2 to 5 cm in diameter, no nodal involvement, and no metastasis)--were treated at St. Vincent's Hospital and Medical Center between January 1, 1965, and December 31 1976. Eighty-three were classified as being at low risk 190 at intermediate risk, and 130 at high risk. At 10 years, 100% of the low-risk group were alive; 99% were free of disease, and any type of mastectomy performed--radical, modified radical, or total--was adequate. At 10 years, 44% of those at high risk were alive, and 30% were free of disease. Radiotherapy improved life expectancy when added to radical mastectomy in the high-risk group. We recommend a prior excisional biopsy for proper histologic evaluation to allow a more appropriate choice of surgical procedure.

Pathologic identification of poor prognosis stage I (T1N0M0) cancer of the breast.

Twenty to 40% of Stage I(T1N0M0) cancers of the breast recur in ten years. This is an attempt to identify those patients in whom the disease is likely to recur. On the basis of a study of the histologic changes in the tumor and treatment failures poor prognosis was associated with several histological characteristics: poor cytologic differentiation; lymphatic permeation; blood vessel invasion and invasion of the tumor into the surrounding soft tissue. This classification was then applied to 363 cancers of the breast seen over a five year period and followed three to eight years. There were 203 Stage I (T1N0M0) tumors in the group. Ninety-four of the 203 Stage I tumors had one to four of the above histologic characteristics; 109 had none. Among the 109 patients characterized as good risks there were two treatment failures (2%). In the group of 94 with any high risk histologic features there were 47 treatment failures (50%) which were statistically significant (p = 0.001). The histologic changes had a cumulative effect on the degree of malignancy of the tumor. Pathologic changes in the tumor identified those patients whose Stage I (T1N0M0) tumors were likely to recur.