NEUROENDOCRINE TUMORS OF THE LUNG WITH SURGICAL RESECTION AND LYMPH NODE DISSECTION IN A TERTIARY THORACIC SURGERY CENTER.

CONTEXT: Management of neuroendocrine tumors is highly dynamic, in both diagnosis and treatment. OBJECTIVE: Surgical resection with lymph node approach offers excellent 5-years survival. DESIGN: Between 2008 and 2011 we operated with radical intent 326 lung cancers. PATIENTS AND METHODS: Cases without lymph node approach were excluded. We found 38 neuroendocrine malignancies: 12 typical carcinoids, 3 atypical carcinoids, 4 large cell neuroendocrine carcinomas (LCNEC) and 10 small-cell lung cancers (SCLC). Limits of the study are: variable lymphadenectomy technique; absence of PET - CT and EBUS-TBNA (EndoBronchial UltraSound - TransBronchial Needle Aspiration) for staging; incomplete data for disease-free survival. RESULTS: We performed 13 pneumonectomies, 22 lobectomies and 3 non-anatomical resections. There were 5 bronchoplasties. The 5-year survival difference between NSCLC (non-small-cell lung cancer - 42.9%) and SCLC (40.53% - one of the best from the literature) is not statistically significant (p=0.4780). Five-years survival was 100% for typical and atypical carcinoids - the best published. We found lymph node metastasis in 2 typical carcinoids, in 2 atypical carcinoids and in 6 SCLCs. CONCLUSIONS: For typical and atypical carcinoids, radical resection with lymphadenectomy offers 100% 5-years survival. Early-stage SCLC may benefit from radical resection; lymph node dissection is mandatory because of the well-known precocious lymphatic dissemination.

Hypogyrification in obsessive-compulsive disorder.

BACKGROUND: Previous studies hypothesized that neurodevelopmental risk factors may play a role in the pathogenesis of obsessive-compulsive disorder (OCD). Cortical folding has been shown to be a reliable indicator for normal and altered neurodevelopment, but in OCD it has barely been investigated up to now. The present study investigates whether alterations in gyrification are detectable in OCD and, if so, how these are associated with clinical characteristics. METHOD: We compared the local Gyrification Index (lGI) between 75 OCD patients and 75 matched healthy subjects across the whole brain. In addition, for those regions exhibiting an altered lGI in patients we explored a potential relationship to symptom severity, age of onset, and influence of medication. RESULTS: OCD patients had a significantly decreased lGI in right parietal, precentral but also insula, temporal, pars triangularis and rostral middle frontal regions compared to healthy subjects. A positive association with age of onset was found but no association with symptom severity. There was no effect of co-morbidity or medication. CONCLUSIONS: The reduced gyrification found in OCD confirms previous findings in other psychiatric disorders and suggests that alterations may already occur during early stages of brain development. Our findings support the idea that altered cortical folding might represent a trait characteristic of the disorder although longitudinal studies are needed to clarify the trajectory of this morphological measure in OCD.

Connectomics-based structural network alterations in obsessive-compulsive disorder.

Given the strong involvement of affect in obsessive-compulsive disorder (OCD) and recent findings, the current cortico-striato-thalamo-cortical (CSTC) model of pathophysiology has repeatedly been questioned regarding the specific role of regions involved in emotion processing such as limbic areas. Employing a connectomics approach enables us to characterize structural connectivity on a whole-brain level, extending beyond the CSTC circuitry. Whole-brain structural networks of 41 patients and 42 matched healthy controls were analyzed based on 83 × 83 connectivity matrices derived from cortical and subcortical parcellation of structural T1-weighted magnetic resonance scans and deterministic fiber tracking based on diffusion tensor imaging data. To assess group differences in structural connectivity, the framework of network-based statistic (NBS) was applied. Graph theoretical measures were calculated to further assess local and global network characteristics. The NBS analysis revealed a single network consistently displaying decreased structural connectivity in patients comprising orbitofrontal, striatal, insula and temporo-limbic areas. In addition, graph theoretical measures indicated local alterations for amygdala and temporal pole while the overall topology of the network was preserved. To the best of our knowledge, this is the first study combining the NBS with graph theoretical measures in OCD. Along with regions commonly described in the CSTC model of pathophysiology, our results indicate an involvement of mainly temporo-limbic regions typically associated with emotion processing supporting their importance for neurobiological alterations in OCD.

Bronchoanastomotic and bronchoplastic resections in pulmonary malignancy retrospective study 2000 - 2009.

UNLABELLED: Bronchial resections are surgical procedures in which bronchial continuity is interrupted, followed by reconstruction of resected ends through terminal anastomosis or various forms of plastic procedures. The purpose of these interventions is to preserve functional lung parenchyma. These procedures are indicated in tumors with central location as an alternative to pneumonectomies, serving to preserve maximum functional lung parenchyma. MATERIAL AND METHODS: We considered bronchoanastomotic and bronchoplastic procedures performed in our clinic over the period 2000-2009, for malignancy. There were 52 bronchoanastomotic resections and 9 bronchoplastic resections of which we analysed 40 bronchoanastomotic resections and 4 bronchoplastic resections (44 cases) ± associated resection. We excluded cases with non-malignant pathology or those with incomplete data at the beginning of the study. RESULTS: The importance of the main factors involved in relation with survival was calculated. We considered the type of surgery performed, histological type, TNM stage, and characteristics of the study group (age, sex). We found statistically significant correlations between survival and histopathology of malignancy with a better survival for lung carcinoids, especially for typical carcinoid tumors. TNM stage did not significantly influence survival, but N2 nodal involvement,according to the statistics, shows a poor prognosis. Age is another statistical significant factor correlated with post operative life expectancy, patients over 65 years old having a worse postoperative survival. CONCLUSIONS: In the corresponding lung malignant pathology, bronchoanastomotic bronchoplastic resections are indicated,but one must take into account the patient's age before submission to surgery, the histopathologic type and N2 nodal involvement.

Diffusion tensor imaging (DTI) studies in patients with obsessive-compulsive disorder (OCD): a review.

This review presents an overview of studies investigating white-matter integrity in patients with obsessive-compulsive disorder (OCD) using diffusion tensor imaging (DTI). There is increasing evidence for white matter alterations in OCD. In adult patients the majority of all studies reported abnormalities in terms of decreased fractional anisotropy (FA) compared to healthy volunteers. Although findings are heterogeneous, the cingulate bundle, the corpus callosum and the anterior limb of the internal capsule are most commonly affected by decreased white matter integrity in adult OCD patients. In pediatric and adolescent patients initial evidence points more towards increased white matter connectivity. Thus, current results suggest alterations in various white matter regions in both pediatric and adult OCD patients. They indicate that alterations may vary as a function of clinical characteristics and may be amenable to pharmacologic treatment. Although the findings have important implications for the neurobiology of OCD they also raise a number of important questions that are discussed in this review and need to be taken into consideration in future studies.

Hypertensive late hemothorax following left pneumonectomy.

INTRODUCTION: Lung cancer is an extremely serious disease, in most cases the onset of symptoms comes in late stages of the disease. Local and distant tumor development limits the surgical indication, many times the surgical act being a heroic one. Out of all pulmonary resections pneumonectomies are real challenges as possible postoperatory complications can be life-threatening. MATERIALS AND METHOD: We present the case of a 66 year-old female patient at the time of surgery, diagnosed with locally advanced adenocarcinoma of the left lung (lower lobe tumor invading the upper lobe), who sustained left pneumonectomy with mediastinal lymphadenectomy in March 2012. Immediate postoperative evolution was favorable" gradual reduction of the residual cavity, with left shift of the mediastinum€" basically a normal post-pneumonectomy course. RESULTS: Upon imagistic control at one year postoperatively the following was observed: the residual cavity had increased in size under the pressure of a fluid which instead of diminishing in quantity was present in a significantly higher volume than on previous postoperative examinations. The general consensus was that we are dealing with pleural metastases which were producing excess pleural fluid. The evolution of the patient and subsequent surgical interventions have demonstrated that the first impression is not always the truth. CONCLUSION: There are cases, like the one presented, which seem without therapeutic solution. Upon careful analysis, dubled by perseverance, these cases benefit from spectacular results which break down grim hypotheses previously formed. Associated pathology can create in these cases an unbalance in the organism, which will negatively influence local postoperative evolution.

[Hydatid cyst of anterior mediastinum]. / Chistul hidatic al mediastinului anterior.

INTRODUCTION: Echinococcosis is endemic in Romania. Hydatid cyst can develop in any segment or organ, but the most frequent locations are liver and lung. Mediastinal hydatid lesions are extremly rare and only a few cases exists in the medical literature. MATERIAL AND METHOD: Between 1994 and 2011 Thoracic Surgery Clinic, UMF "Carol Davila" there were 3 patients diagnosed and surgical trated for hydatid cyst of mediastinum. The patients were 2 men and 1 woman aged of 20, 37 and 52 years. All hydatid cysts were located in the anterior mediastinum and all were solitary lesions when diagnosed. RESULTS: In 1 case the positive diagnosis was made preoperatively, in the other 2 the diagnosis was intraoperative. The approach was through thoracotomy. One cyst was complicated (nonviable thymic hydatid cyst), treated by ideal cystectomy, and 2 cysts were viable. There was 1 postoperative complication: gaseous cerebral embolism remitted after medical treatment, caused by the intraoperative use of H2O2 as scolicide agent. CONCLUSIONS: Although very rare, anterior mediastinal hydatid cysts must be considered in every patient with anterior mediastinal mass. Complete surgical excision is the treatment of choice; surgery followed by parasiticide therapy provides complete cure.

[Neurogenic tumors of the posterior mediastinum]. / Tmorile neurogene ale mediastinului posterior.

The posterior mediastinum is the potential space along each side of the vertebral column and adjacent proximal portions of the ribs--the paravertebral sulci. From the posterior mediastinal tumors, the most commonly encountered are the neurogenic tumors (75%), the remaining 25% are represented by a heterogenous group of rare tumors including teratoma, lymphoma, sarcoma and other lesions arising outside the mediastinum and projecting into the posterior compartment. Surgical excision, by thoracotomy or miniinvasive techniques, is the first line of treatment in the posterior mediastinal tumors. Tumors with extension into the spinal canal (dumbbell tumors), accounting for nearly 10% of the posterior mediastinal tumors, require a multidisciplinary approach: thoracic surgeon and neurosurgeon. We present the experience of the "Carol Davila" University of Medicine and Pharmacy Thoracic Surgery Clinic in the surgery of neurogenic posterior mediastinal tumors throughout a 9 year period (2001 - 2010). 42 cases admitted and operated in this period are being analysed.

[Solitary pulmonary nodule--150 resected cases]. / Nodulul pulmonar solitar--150 de cazuri operate.

Solitary pulmonary nodule represents a radiological entity with unknown prevalence in general population. As definition, solitary pulmonary nodule has 3 cm diameter or less and is surrounded by lung parenchyma, with no other abnormalities on the same chest X-ray or CT scan film. The differential diagnosis of the solitary pulmonary nodule includes over 100 conditions and the most frequent is lung cancer. Identification and correct management of the solitary pulmonary nodule opposes early detection and treatment of the lung cancer and the uselessness of a surgical procedure on a benign disease which needs no treatment. After analyzing 150 solitary pulmonary nodules resected and after comparing the results with the literature, given the fact that 48.66% of the nodules are malignant and 52.66% of the nodules have the maximum accepted dimensions (3 cm), the authors proposed an algorithm for solitary pulmonary nodule management adapted to Romania's accessibility to diagnostic procedures. As conclusion, the surgical resection of an indeterminate solitary pulmonary nodule (not certified as benign at CT scan or by biopsy) has an absolute indication and curative intention.

Giant laterocervical fibrosarcom.

Soft tissue sarcomas are rare tumors representing 1% of all malignancies and less than 10% concerning head and neck tumors. We are presenting the case of a 42-year-old patient that was admitted in our service for a giant laterocervical tumor (15/12/10 cm). We performed total excision of this tumor en bloc with the involved tegument; the resulting defect was covered with a split thick skin graft. The weight of the tumor was 500 g. Histopathological examination revealed an intermediate-grade fibrosarcoma. The postoperative evolution was good; radiotherapy was indicated.

[Determining role of media in peroxide oxidation of aromatic type antioxidants with participation of methemalbumins]. / Opredeliaiushchaia rol' sredy v peroksidnom okislenii antioksidantov aromaticheskiogo riada s uchastiem metgemal'buminov.

Participation of the complexes of hemin and albumins (or delipidated albumins) in peroxidation of aromatic free radical scavengers and antioxidants was studied at varying hemin/albumin ratios. The radical-scavenging amines included o-phenylenediamine (OPD) and tetramethylbenzidine (TMB); the antioxidants, gallic acid (GA) and GA polydisulfide (GAPD). Peroxidation reactions were carried out in buffered physiological saline (BPS) supplemented with 2% dimethylsulfoxide(DMSO), pH 7.4 (medium A), or in 40% aqueous dimethylformamide (DMF), pH 7.4 (medium B). In all systems involving methemalbumins, kinetic constants (kcat), Michaelis constants (kM), and the ratios thereof (kcat/kM) were determined for OPD oxidation in medium A and TMB oxidation in medium B. Oxidation of OPD, GA, and GAPD in medium A was characterized by a decrease in the catalytic activity of hemin after the formation of hemin-albumin complexes. Conversely, oxidation of TMB and OPD in medium B was distinguished by pronounced activation of hemin present within methemalbumins.

[Spectrophotometric and fluorometric study of albumins and hemin interactions with aromatic antioxidants]. / Spektrofotometricheskoe i fluorimetricheskoe issledovanie vzaimodeistviia al'buminov i gemina s antioksidantami aromaticheskogo riada.

Difference spectrophotometry and fluorescence quenching of human and bovine serum albumins were used to determine their association constants (Ka) with hemin in buffered physiological saline (pH 7.4) supplemented with 2% dimethylsulfoxide or in 40% aqueous dimethylformamide (pH 7.4). Ka values depended on the medium, the extent of albumin delipidation, and on the method of determination. The formation of hemin complexes with o-phenylenediamine, tetramethylbenzidine, gallic acid, its polydisulfide, and two substituted di-tert-butyl pyrocatechols was studied by difference spectrophotometry in the same media; Ka values for the complexes were calculated and compared to each other. The formation of complexes of these aromatic ligands with albumins was studied fluorometrically; Ka values were of order of approximately 10(-5) M-1 and decreased with the ligand hydrophobicity.

Inhibition of oxidation of aromatic amines in heme-containing hydrogen peroxide systems by substituted 4,6-di-tert-butyl-pyrocatechols.

The substituted pyrocatechols sodium (2,3-dihydroxy-4,6-di-tert-butyl-phenyl)-S-thiosulfate (InH1) and 3-(S-glutathionyl)-4,6-di-tert-butyl-pyrocatechol (InH2) effectively inhibited oxidation of o-phenyle-nediamine and tetramethylbenzidine (TMB) catalyzed by hemin or its complex with BSA (methemalbumin). The method of competitive reactions of aromatic amines (PDA, TMB) and pyrocatechols (InH1, InH2) with active radicals was used for the quantitative determination of rates of radical initiation in systems containing hemin (methemalbumin) and H2O2 (TBHP). The use of the inhibitor method for heme-protein-peroxide systems is complicated by heterogeneity of the radicals generated (HO., RO., HO2., RO2., peroxide-like compounds I and II), formation of complexes of the inhibitors with protein component, and possible interaction of active radicals with organic co-solvents (DMF or DMSO). The system hemin (methemalbumin)-H2O2 (TBHP)-aromatic amines can be used for testing the efficacy of potential bioantioxidants.

[Methemalbumin--a biocatalyst of aromatic amine oxidation by hydrogen peroxide]. / Metgemal'bumin--biokatalizator okisleniia aromaticheskikh aminov perekis'iu vodoroda.

The kinetics of hydrogen peroxide-dependent oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) and o-phenylenediamine catalyzed by hemin and hemin-bovine serum albumin (BSA) complex (methemalbumin) was studied in buffered physiological solution containing dimethylformamide (40%) and dimethyl sulfoxide (2%), respectively. The formation of hemin-BSA complex enhanced hemin catalytic activity in oxidation of both amines. The reaction follows first-order kinetics in biocatalyst concentrations, H2O2, and H+ ions from pH 6.5 to 9.0. The catalytic constants, Michaelis constants, and kcat/K(m) ratios for both substrates in hemin- and methemalbumin-catalyzed reactions were calculated using double reciprocal plots of the effect of the initial TMB and PDA concentrations on the initial reaction rates. Mechanism of radical oxidation of amines in hemin-H2O2 and hemin-BSA-H2O2 systems is discussed. Both systems can effectively initiate radicals free radicals formation; their activity is similar to the previously studied ferritin-H2O2 system.