Search

Objective: In several previous studies, including one of our own, CT and MRI provided similar information on N2 detection in the staging of lung cancer. Both imaging techniques can be considered effective in detecting enlarged mediastinal lymph nodes but the results are often inaccurate when confronted with pathological findings. The purpose of this study was to assess the diagnostic accuracy of gadolinium-DTPA enhanced MRI in the detection of mediastinal lymph nodes in lung cancer., Methods: A prospective study to compare standard unenhanced MRI and Gd-DTPA enhanced MRI was carried out in patients with diagnosed lung cancer. The study focused on the status of mediastinal lymph nodes. Gd-DTPA was administered at a dosage of 0.2 mmol2/KG before T1 weighted sequences. Qualitative visual analyses of both standard and contrast enhanced MRI images were performed on each patient by 2 independent radiologists. The imaging results were then compared to pathological findings obtained after surgical operation., Results: In the identification of mediastinal lymph node metastases standard MRI was 62% sensitive, 100% specific and 74% accurate whereas Gd-DTPA enhanced MRI was 100% sensitive, 91% specific and 97% accurate., Conclusions: Gd-DPTA enhanced MRI was more accurate than standard MRI in the detection of metastatic lymph nodes in patients with lung cancer. These initial results can be considered encouraging especially with regards to the reduction of false negative findings although further confirmation is, understandably, required.

A 56-year-old male patient came under our observation when a peripheral round mass in his right lung which he had since 1991 and which was believed to be a bronchogenic cyst, showed a volumetric enlargement of 2 cm. After performing a lobectomy of the middle lobe, the histopathological examination revealed the presence of a mucinous cystadenoma of borderline malignancy.

Clinical research on 75 cases of mediastinal masses has been carried out with the aim of evaluating the diagnostic value of Magnetic Resonance (MR). Results which have been achieved point to a remarkable potentiality of MR especially in the characterization and spatial definition of the masses and in the study of the spinal canal. These results, as well as the non-invasivity of the procedure, lead us to consider MR as an investigation of primary importance in the diagnostic assessment of mediastinal pathology.

Objective: Video-assisted thoracoscopic surgery (VATS) represents at present the most suitable treatment of recurrent spontaneous pneumothorax. After three years we consider this interesting to draw up a trial balance of our VATS experience in comparison with the cases treated before 1991 with the classic thoracotomic approach., Methods: We have considered retrospectively the results obtained in a series of 30 consecutive patients with recurrent spontaneous pneumothorax treated with VATS between November 1991 and August 1994 in comparison with those obtained in a group of 30 patients previously treated with a traditional thoracotomy. The groups have been selected in such a way that surgical indications, sex ratio, age and number of episodes were homogeneous. The parameters we have compared were the postoperative complications, the duration of chest drainage and hospitalization, the operating times and the relapses. Besides these technical parameters we considered the economic data too., Results: On average drains removal occurred one day before in VATS-Group: the time spent in the Hospital was significantly shorter in VATS-Group, being on average 1 week. Short term complications may be considered similar in the two Groups. Prolonged air leaks occurred in 13% and 16% respectively. Emothorax requesting reoperation occurred in 1 case for each Group. One death occurred in thoracotomy-Group in an old patient presenting a severe chronic respiratory insufficience with exacerbation in postoperative time. We have registered 2 relapses after VATS and none after thoracotomy., Conclusions: The study has demonstrated the therapeutic efficacy of VATS and in the same time that in VATS the total economic cost is lower (22.7%) in comparison with traditional thoracotomy.

The great interest in VATS over the last few years has extended the indications for this technique in order to avoid risks. There are additional indications (e.g. spontaneous pneumothorax), including several benign diseases of the lung, pleura, mediastinum and oesophagus. But other indications for the procedure are still controversial, for example lung resection for primary bronchial cancer. In this report the Authors, on the basis of their own experience, try to define the present and approaching perspectives for VATS.

Non-small cell lung cancer (NSCLC) shows a complex cytogenetic heterogeneity and up to now no particular chromosomal aberration seems to characterize its malignant evolution. We therefore performed cytogenetic analyses of 20 primary NSCLC, 8 adenocarcinomas and 12 squamous cell carcinomas on direct preparations or short-term cultures. Only 1 case was analyzed after long-term culture. Results were obtained from 11 samples and clonal rearrangements were found in 3 cases, a diploid and a near-triploid clone with several aberrations such as i (9q), rob (14; 15) and rob (21; 21) in 1 case, a near-triploid clone in 1 case, and Y chromosome loss in 1 case. Other aberrations found were sporadic, but +7 aneuploidy and translocations involving 1p were detected in 2 and 3 samples respectively. Although to date it has been very difficult to recognize primary changes in NSCLC, nevertheless a literature review and our results indicate that i(9q) and robertsonian translocations are relevant findings.

Fifty patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. Results of CT and MR were compared with the surgical and pathology findings. No statistically significant difference was found between the two imaging methods for the evaluation of node involvement (N2). MR appear to be superior to CT in the aortopulmonary and subcarinal areas.

Twenty-five patients with bronchogenic carcinoma were prospectively studied by both CT and MR during 10 days preceding thoracotomy. MR scans included contiguous axial and coronal slices. Results of CT and MR studies were compared with the surgical and pathological findings. Although no significant difference was found between the two imaging methods for the evaluation of mediastinal nodes. MR appear to be superior to CT in the aortopulmonary and subcarinal node areas.

From July 1979 to July 1986, 215 patients with non-oat cell carcinoma of the lung were treated by surgery at our institution. Of these, 169 had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The extent of pulmonary resection consisted of pneumonectomy in 70 patients, lobectomy in 78 patients, bilobectomy in 18 patients and wedge resection in 3 patients. All were staged according to the AJG staging system. There were 88 patients without lymph node metastases (N0), 10 patients with peribronchial lymph node metastases (N1) and 60 patients with regional lymph node metastases (N2). All patients with N2 disease received radiation therapy to the mediastinum after surgery. The overall survival rate was 62% at 1 year, 36% at 3 years and 27% at 5 years. Survival in patients with N2 disease was 56% at 1 year, 23% at 3 years and 12.4% at 5 years. We conclude that patients with mediastinal lymph node metastases can be effectively treated by combined resection and radiation therapy, with prolonged survival.

The diagnostic significance of the histological typing of lung cancer carried out on preoperative bronchoscopic biopsy samples is assessed in relation to final morphological diagnosis on operating material. In this connection 176 of 624 cases of lung cancer documented histologically from January 1980 to December 1987 in which preoperative biopsy sample was followed by removal of the lung are analysed. The 4 basic histotypes of lung cancer according to the WHO (1981) classification are considered. A positive diagnosis for cancer was encountered in 138 cases (78.4%) with histotype confirmed in 122, whereas a negative diagnosis was encountered in 38 cases (21.6%). These findings also permitted further considerations, including the possible limitations of the technique.

Interstitial implantation of I125 by thoracotomy represents a further therapeutic procedure for lung cancer. Two cases recently treated by this procedure are reported. The first case concerns a right apical carcinoma of the lung where interstitial implantation of I125 seeds was carried out in the unresectable apical neoplastic residue, after superior lobectomy. The second case concerns a smaller tumor unresectable due to the severely impaired respiratory function. Main indications to the procedure are reported.

Cancer of the lung is becoming increasingly common. In the U.S., it has the highest mortality of the neoplastic diseases, well ahead of cancer of the colon and rectum. Surgical and/or complementary management is poorly effective because it comes too late. Early diagnosis and treatment are essential, therefore. Preclinical diagnosis may be possible radiographically in certain fortunate cases, but this is never an early diagnosis. The latter is only possible through active bronchial cytology (bronchial brushing, selective washing, PBS) during and after flexible fibrobronchoscopy, which can be carried out under local anaesthesia at the outpatient level and causes very little distress to the patient. Data from a personal series are cited in support of the view that cytodiagnosis should be routinely employed in subjects at high risk (heavy smokers, persons with chronic bronchitis, emphysema, etc.).

Twenty-two patients with surgically incurable lung cancer undergoing systemic chemotherapy have been studied with serial determinations of CEA levels during their therapy. The changes of CEA levels in each patients showed that the assay may be useful to evaluate the effects of therapy. The purpose of this preliminary study is to explore the possibility that CEA assay may be a useful guide to the subsequent clinical response of the patient to the drug.

In pursuance of an investigation of oesophageal physiopathology, a study has been made of the problem of the functional regulation of the inferior oesophageal sphincter in the light of new findings. Experiments carried out on six dogs made it possible to study functional modifications of the oesophagus after vagotomy, completing the technique by administering pentagastrin for the first time in vivo. Radiological and mano metric controls showed in the post-operative period a dilated oesophagus with a fall, in the lower third, of normal pressure values that did not undergo change, unlike what happened in the non-denervated oesophagus after administration of pentagastrin. The results obtained show that the integrity of the nervous structures is not only necessary for the perfect coordination of oesophageal peristalsis, but vital for normal functional response of the inferior oesophageal sphincter, since gastrin action is always mediated by release of acetylcholine by the post-gangliar vagal nerve endings.

A series of 39 operated cases of small cell cancer were analysed. In 15 cases (38.4%) an exploratory thoracotomy only was carried out. 24 patients (61%) had a pulmonary excision: 12 pneumonectomies, 3 bilobectomies and 9 lobectomies were carried out. The hospital mortality was 7.7%. After a study of the surgical specimens these 21 cases were grouped as follows: 5 stage I, 1 stage II and 15 stage III. After surgery 4 patients were treated with radiotherapy alone, 3 chemotherapy alone and 10 by a combination of radiotherapy followed by chemotherapy, finally 4 patients had no post operative treatment. For the 21 patients who had resections the actuarial survival was 12.8% at 5 years and the mean survival 24 +/- 17.2 months. These results were judged as satisfactory and lead one to consider the current place of surgery in the treatment of small cell bronchial cancer.