Histopathological grading of response to induction chemotherapy in non-small cell lung cancer: a preliminary study.

Management of locally advanced NSCLC is controversial. Induction chemotherapy followed by surgery has become an accepted approach for Stage III disease. However, the clinical assessment of the efficacy of preoperative treatment is inaccurate. We propose a four-grade histopathological evaluation of the response to chemotherapy based on the analysis of 20 evaluable cases and compared with clinical outcome. Follow-up ranged from 12 to 68 months. Correlation between different grading of necrosis and survival is statistically significant. Based on these preliminary results, we suggest that grading of response is a valid parameter to evaluate standard regimens and novel drug associations in larger trials.

[Pulsating tumor of the sternum: enlarged exeresis and reconstruction with marlex-methylmethacrylate prosthesis]. / Tumore pulsante dello sterno: exeresi allargata e ricostruzione con protesi di marlex-methyl-methacrylate.

The authors report on a rare case of pulsating tumor of the sternum. En bloc resection was carried out with removal of the sternal manubrium and body, tracts of the I-II-III rib with the intercostal muscles and part of the left pectoralis major. Reconstruction of the thoracic wall was performed with a marlex MMA sandwich prosthesis. From a histological viewpoint, the carcinoma was well differentiated and compatible with thyroid primitivity. Non complementary antiblastic therapies were provided as all the examinations carried out were negative and the intervention was radical. The patient had been followed-up with serial controls and three complete stagings at one, three and five years after intervention (CT, echography and function tests of the thyroid, bone scintigraphy). At follow-up of more than six years the patient is doing well and is event free. The authors believe, even with the help of reports from the literature that, in sternal metastases from thyroid carcinomas, especially when single and large, surgical therapy is required.

Castleman's disease presenting as an asymptomatic solitary pulmonary nodule.

We report the case of a 51 year old white woman with an asymptomatic solitary pulmonary nodule, fortuitously discovered on chest radiography. Her physical examination and biochemical tests were unremarkable for pathological findings. Thoracic computed tomography (CT) scan and nuclear magnetic resonance (NMR) spectroscopy confirmed the presence of a dishomogeneous thick lesion of lobular shape, localized between the middle and lower lobe of the right lung. Fibreoptic bronchoscopic examination failed to produce histological diagnosis of the lesion. Surgical removal of the lesion demonstrated intraparenchymal localization of Castelman's disease (giant lymph node hyperplasia). Three years after surgery, no sign of disease recurrence has been recorded.

[Surgical correction of pectus excavatum]. / Correzione chirurgica del pectus excavatum.

From 1979 to March 1993 a corrective surgical operation was performed on 14 patients with pectus excavatum. Patients' age ranged between 11 and 23, (mean value 16); 11 were males and 3 females with family history of deformities of the thoracic wall in 5 cases and scoliosis in 8. In 11 patients the defect was present at birth or during the first year of life. At present, the following examinations are carried out routinely: X-ray of the chest in the two standard positions and of the backbone, spirometry and ECG in standard conditions and under stress, Doppler echocardiogram, CT, psychomotor and intellectual behaviour test. Indication to surgery was for marked deformity and resulting cardiorespiratory physiopathologic repercussions present or expected in future. The surgical technique performed, a modification of the Ravitch procedure, was sternochondroplasty. A temporary stabilization support was added in 9 patients between the age of 16 and 23 (Rehbein plates in 3, sliding staplesplints in 6) so as to prevent secondary depressions. There were no deaths in this series. Cosmetic results were satisfactory with disappearance of a psychosomatic troubles.

[Surgical stabilization of post-traumatic flail chest. Our experience with 116 cases treated]. / La stabilizzazione chirurgica del lembo costale mobile post-traumatico. Nostra esperienza relativa a 116 casi trattati.

The therapeutic approach in a patient with traumatic flail chest is varied and controversial, both as regards the type of treatment and as regards the surgical techniques to be employed. The authors have examined 116 cases of flail chest treated surgically; these represented 17.7% of the 655 chest traumas operated in the period from July 1975 to March 1993. Increasing experience has reduced indications for surgery: at present it is not performed in cases of serious craniocerebral lesions, of severe pulmonary contusions, or, however, when mechanical ventilation is required. As for surgical techniques, external traction was applied in the first 15 cases treated but then discontinued because of the poor outcome. Osteosynthesis (77 cases), associated with thoracotomy, was carried out with Kirschner wires, Vecsei metal plates, Judet agraffe, alone or variously combined. Recently, a less aggressive personal technique has been employed prevalently: Kirschner wires placed vertically within the chest, bridging between one rib (generally the V or VI, well fixed with metal plates), and the clavicle and/or sternum. The overall mortality rate, prevalently due to associated lesions, was 20.6%. Excluding emergencies, these patients should be operated in deferred emergency within 24-48 hours of trauma. Osteosynthesis, when indicated is the procedure offering the greatest assurance of success. The authors believe that, in selected cases, surgical stabilization is necessary.

[Recurrence of bronchial cancer after surgery. Radiologic data]. / Récidives du cancer bronchique après chirurgie. Données radiologiques.

The post-surgical malignant recurrences of bronchogenic cancer may be classified as local, regional, locoregional. The present series is based on 115 patients observed in 1982-1987. In all of them a tumour recurrence was clinically and/or radiologically suspected: the histological findings or the follow-up confirmed such a diagnosis in 52 cases. A correct radiological assessment is based on a full knowledge of three items: 1) early and late complications of the surgical intervention; 2) available diagnostic tools for a differential diagnosis between usual post-operatory sequelae and neoplastic recurrences. 3) pathologic history of the patient and his tumour.

[Symphyseal therapy with tetracycline in neoplastic pleurisy and spontaneous pneumothorax]. / La terapia sinfisaria con tetraciclina nelle pleuriti neoplastiche e nel pneumotorace spontaneo.

The treatment of 15 patients with neoplastic pleurisy and 25 with spontaneous pneumothorax occurring for the second time is described. All were given endopleural tetracycline therapy for symphyseal purposes. In the neoplastic pleurisy cases, the treatment reduced the number of thoracenteses required. In only 1 case did spontaneous pneumothorax recur a short time after treatment.

[Isolated communication between the left atrium and the coronary sinus (author's transl)]. / Comunicazione atrio sinistro seno coronarico isolata. Raro caso corretto con tecnica personale.

The communication between the coronary sinus and the left atrium is a very exceptional case. In this work the AA. report the difficulties of the pre and peroperating diagnosis, above all because the coronary sinus, in this case, is not enlarged, but usual. The identification of the malformation, that is also isolated, is difficult also at the surgery, if you don't make a left atriotomy. A personal operative method of correction is reported.