Local resection of pulmonary lesions by Nd-YAG laser without suturing

Local excision of 67 pulmonary lesions in 5 patients was performed with the Nd-YAG laser. There were 2 women and 3 men with an average age of 68 years. The patients consisted of three cases of metastatic lung cancer (65 lesions), one hamartoma (One lesion) and one organized pneumonitis (one lesion). The lesion was first enucleated by a contact method using an Nd-YAG laser scalpel, then the crater of the resected lesion in the normal lung tissue was coagulated with a defocused laser beam. The craters of 52 of the 67 resected lesions which were shallow seated in the lung were left open, but the other 15 resected lesions were closed with sutures. Total blood loss was less than 100 ml. There was no bleeding or air leakage (30 cm water pressure) during the post operative days in 4 of the 5 patients, but one patients (one lesion) had to be treated by bronchoscopic endobronchial embolization against a persistent air leak. This lesion was 2.5 cm in diameter and 4 cm deep in the lung on CT. The other lesions were also measured by CT. The tumor size was 1.4 +/- 0.7 cm and the depth was 2.4 +/- 1.0 cm. The Nd-YAG laser is very suitable for local resection of peripheral lung lesions without suturing.     

The effect of beta-adrenergic blockade on non-esterified fatty acid uptake of exercising skeletal muscle during arm cranking

A case of 62-year-old male patient with tuberculosis in the lower lung field of right side was reported. The case showed a solitary lesion in S8b of 2.5 x 2.0 cm in size and was detected by the mass survey. The case was complicated with chronic renal failure and was treated by lobectomy because of suspicion of lung cancer, as there was a marked pleural indentation on CT. By examining the resected specimen, the following findings were revealed. The solitary exudative tuberculous lesion located in the margin of the basal segment extended both to the costal and diaphragmatic pleura, and a small triangular shaped normal lung parenchyma located at the periphery of the lesion was isolated, and the air flow from the lower lobar bronchus was cut. As a result, hyperinflation of the isolated normal lung took place through collateral air leak and check-valve mechanism (The Culiner Theory), finally the pleural constriction was formed at the boundary between the lesion where the elasticity was lost and the hyperinflated parenchyma.     

Concomitant cardiac and pulmonary operation, the profits of not using cardio-pulmonary bypass

We performed off pump CABG (coronary artery bypass grafting) and right upper lobectomy with R2a lymph nodes dissection on the patient suffered from both lung cancer in the right S1 and stenotic lesion in the left anterior descending artery. Because the coronary lesion was long-segmented one, it was not suitable for percutaneous transluminal coronary angioplasty. To perform absolutely curative operation for the lung cancer, CABG was undergone simultaneously under off pump condition. It is generally feared that the cardiovascular surgery under CPB may have adverse effect for the patient with malignant lesion. Off pump CABG is expected to avoid such disadvantage of CPB, and thought to be suitable method for such a patient as we present above.     

Perfusion lung scan patterns in 100 patients with bronchogenic carcinoma

The relationship between size of the perfusion defect as seen by perfusion lung scan (PLS) and size of the mass lesion as seen radiologically was correlated with the presence of regional adenopathy in 100 consecutive patients with bronchogenic carcinoma. All patients underwent scanning before open thoracotomy or mediastinotomy and had histologic documentation of the disease. Each perfusion lung scan was classified as follows: (1) perfusion defect larger than the mass lesion. (2) perfusion defect of the same size as the mass lesion, or (3) no focal defect seen. Among patients with a larger perfusion defect 84 per cent were found to have regional lymph node involvements, whereas among patients in whom a larger defect was not present only 23 per cent had such extensions of the disease.     

Gallium-67 scanning for carcinoma of the lung

Gallium-67 citrate scanning was prospectively evaluated in 55 patients who had lung lesions suspected to be primary carcinoma on chest x-ray films and in whom subsequent histologic diagnosis was obtained. Of 47 patients with histologically proved carcinoma of the lung, 44 (94 per cent) had a positive 67Ga scan. No patient with a positive scan had a benign lesion, so that the positive scan accuracy rate was 100 per cent. All 8 patients with a benign lesion and 3 patients with a malignant lesion had negative scans, for a negative scan accurary rate of 72 per cent for benign lesions. These results give statistical validity for the usefulness of the 67Ga scan in diagnosing carcinoma of the lung (p less than 0.001). Tumor cell type had little effect on the sensitivity of 67Ga scan. The 67Ga scan was equally useful in the evaluation of peripheral and central lesions. There was little difference amount T1, T2, and T3 classified lesions in their ability to take up 67Ga. The 67Ga scan was competitive with mediastinoscopy in assessing mediastinal lymph node metastases and provides a noninvasive method of assessing hilar lymph node metastases. There was a good correlation between the clinical staging of patients with lung cancer based on a chest x-ray film and 67Ga scanning and the staging after surgical treatment based on the histology of the resected specimens.     

1998 update on pregnancy in lupus patients. New horizons, new hopes

To clarify features of lung cancer in patients with tuberculosis sequelae, we analyzed data on 15 cases (5.1%) who were diagnosed with lung cancer before death among 294 deceased cases with tuberculosis sequelae at our hospital. There were 12 men and 3 women, with a mean age of 64 years. Most of the 15 patients had pulmonary dysfunction, and 4 had received home oxygen therapy. All 12 men had a history of smoking, and 10 of them had squamous cell carcinoma of the lung. There was no definite correlation between the locations of the tuberculosis lesion and those of lung cancer lesion on chest X-rays. Twelve patients had had thoracoplasty for tuberculosis, and in 6 of these patients the lung cancer occurred in the same lung. Lung cancer was apt to be diagnosed in an advanced stage. However, in patients who received home oxygen therapy, diagnosis had been made at an early stage because of the frequent chest X-ray follow-up. We conclude that lung cancer is an important complication in patients with tuberculosis sequelae, and early diagnosis of lung cancer by careful follow-up is essential in the care of cases with tuberculosis sequelae who have poor pulmonary function and/or systemic conditions.     

A case of lung and liver cystic hydatid disease in a 31-year old man

The case of cystic hydatid disease in a man working in the past in Greece was described. He was admitted to hospital because of a very marked limited shadow in the right lung. During diagnostic procedures, two cysts were revealed in the liver. Punction of lung lesion was not performed. He was operated on with a suspicion of hydatid disease. Diagnosis was supported with a parasitologic examination.     

Iloprost as cyclic five-day infusions in the treatment of scleroderma. An open pilot study in 20 patients treated for one year

OBJECTIVE: To evaluate the safety and efficacy of cyclic intravenous iloprost therapy in diffuse or limited scleroderma. METHODS: Twenty patients, 14 women and 6 men with a mean age of 47.8 +/- 8.2 years, were given iloprost infusions for six hours a day during five consecutive days, at a rate of 0.5 to 2 ng/kg/min. The course was repeated every three months for one year. Efficacy was evaluated based on a scleroderma skin lesion score, an ischemic lesion score, a well-being self-assessment score, and lung function tests including measurement of the diffusing capacity of the lung for carbon monoxide. Safety was assessed based on adverse event collection. RESULTS: The scleroderma skin lesion and ischemic lesion scores decreased significantly over the one-year treatment period, from 37.1 +/- 16.5 to 10.2 +/- 6.9 (P < 0.001) and from 31.8 +/- 19.1 to 2.2 +/- 2.0 (P < 0.05), respectively. The well-being self-assessment score also showed a significant improvement, from 71.4 +/- 16.5 to 15.0 +/- 6.6 (P < 0.001). The diffusing capacity for carbon monoxide was decreased in 11 patients at baseline and showed a slight, non significant increase in these patients after the treatment period. No serious or persistent side effects were recorded. CONCLUSION: Cyclic intravenous iloprost therapy was associated with improvements in skin changes and in general health, as well as with a slight increase in the diffusing capacity of the lung for carbon monoxide. Our data suggest that iloprost may act on some of the pathogenetic mechanisms of scleroderma in a way that improves the course of the disease.     

A case of successful resection of pulmonary arteriovenous fistula with a high shunt ratio

We report on a 25-year-old cyanotic man who was diagnosed as having a pulmonary arteriovenous fistula. His chief complaint had been shortness of breath since childhood. Polycythemia (Hb 21.4 g/dl) was detected during a health checkup at his company. A chest X-ray showed an abnormal mass in the left lung. Blood gas analysis showed severe hypoxia with PaO2 of 38.6 mmHg at room air. Angio-CT showed a large aneurysmal lesion at S6 of the left lung with a large feeding artery and vein. Oxygen saturation was 75.2% in the radial artery and 62.5% in the right atrium. The right-to-left shunt ratio was therefore calculated as 62%. The aneurysmal lesion was resected by segmentectomy of the left S6 following division of A6 and V6. After a successful operation, the patient no longer had shortness of breath or cyanosis and blood gas analysis showed PaO2 as 84.3 mmHg at room air. Pulmonary angiography showed no residual shunt lesion.     

Papillary adenocarcinoma arising in placentoid bullous lesion of the lung: report of a case with immunohistochemical study

We report the case of a 52-year-old man with papillary adenocarcinoma arising in placentoid bullous lesion of the lung, which is a rare cystic lung disease. Macroscopically, the cyst contained a soft villous tumor closely resembling the placental chorionic villi of early gestation. Histologic examination revealed the tumor to be papillary adenocarcinoma with an abundant stromal core, which comprised vascular and lymphatic vessels, lymphocytes, fat cells, and smooth muscle. Immunohistochemically, adenocarcinoma cells were positive for CAM 5.2, epithelial membrane antigen, and PE10 (antisurfactant apoprotein A antibody). These results indicate that the adenocarcinoma was derived from the component epithelial cells of the cyst. Based on the tumor's macroscopic and microscopic appearance and on the results of the immunohistochemical studies, we conclude that the cystic tumor in our case arose in a placentoid bullous lesion of the lung.     

Two cases of metastasizing benign leiomyomatosis from myoma uteri]

Case 1. A 50-year-old woman was referred to our hospital because of multiple bilateral small round lesion on chest radiography. She had undergone total hysterectomy for myoma uteri at the age of 33. She underwent thoracoscopic tumor excision at left lung. The lesion was proved benign. Right side lesions were laterly excised using thoracotomy. Case 2. A 49-year-old woman was referred to us because of two ovoid lesion at left lung area of chest radiography. She also had undergone total hysterectomy for myoma uteri at the age of 37. She underwent tumor extirpation using thoracotomy. All samples of two patients revealed, pathologically, lesions were consisted of benign spindle-like calls similar to those of myoma uteri. Therefore, we consider these lesions were pulmonary metastasis of myoma uteri. Myoma uteri has certain potential of metastasizing to the lung, in spite of benign disease.     

Microbial keratitis as the manifestation of trigeminal amyloidoma at initial presentation

A primary malignant pulmonary hemangiopericytoma was diagnosed in a 45-year-old woman who complained of 10 months of cough and exertional dyspnea. One year after resection of the mass, a metastatic lesion was removed from the contralateral lung. The literature on this unusual pulmonary lesion is reviewed.     

Infected emphysematous bullae in a patient with diabetes mellitus

A 42-year-old woman with diabetes mellitus was admitted to our hospital because of fever, coughing, and dyspnea. Coarse crackles were audible and respiratory sounds were weak in the right lung field. Laboratory examination revealed a high erythrocyte sedimentation rate, a high level of serum C-reactive protein, a high blood sugar level, and hypoxemia. A chest roentgenogram revealed cystic lesions with fluid levels, and an infiltration shadow in the right lung field. A chest computed tomographic scan revealed many cystic lesions with fluid levels and an infiltration shadow. Our diagnosis was infected emphysematous bullae. A tube was inserted percutaneously for drainage and to allow injection of antibiotics into the cystic lesion. The cystic lesion then vanished. Percutaneous drainage and washing with antibiotics can be used to treat infected emphysematous bulla that have thick closed cystic walls.     

Clinical evaluation of a method for detecting superficial surgical transitional cell carcinoma of the bladder by light-induced fluorescence of protoporphyrin IX following the topical application of 5-aminolevulinic acid: preliminary results

Experiments were performed to consider the use of conventional neonatal ventilators with assisted expiratory mechanism using ventilatory high frequency strategies. Gas exchange, hemodynamic state, and lung injury were also assessed. Twenty Albino Wistar rats, undergoing and acute lung lesion through physiological solution wash of the lungs were studied. Afterward, they were distributed into four groups according to the different ventilator strategies, based on the different pressure changes and the tidal volume, the baseline lung volume and the respiratory frequency. Group I, High Frequency Ventilation, with high baseline lung volumes (HFVh); group II, Conventional Mechanical Ventilation, with high baseline lung volume (CMVh), group III, High Frequency Ventilation, with low baseline lung volume (HFV1) and group IV Conventional Mechanical Ventilation, with low baseline lung volume (CMV1). Significant differences were found between group I (HFVh) and groups II (CMVh), III (HFV1) and IV (CMV1) as regards pO2, Artery/Alveolar relation to O2 (a/A), pCO2, arterial blood pressure and histopathologic lung lesion. The hypothesis concerning the decisive role of the baseline lung volume maintainence to minimize progressive damage caused by mechanical ventilation on a previously injured lung while attending ventilatory strategies that generate little pressure and volume cyclical changes was confirmed. We conclude that, high frequency mechanical ventilation is possible through conventional neonatal respirators with assisted expiratory mechanism.     

Detection of abscesses with Tc-99m HMPAO leukocyte scintigraphy depends on their stage and location

Two abscesses were shown on CT in a 72-year-old man: one in the left hip and one in the left pelvic region that resulted from a motor vehicle collision that occurred 8 months earlier. Bone scintigraphy showed increased uptake in the left hip area. On Tc-99m HMPAO leukocyte imaging, the hip area appeared to be photopenic, and the abscess of the left pelvis was not identified. Incidental uptake in the left lung base appeared to be an active acute inflammatory process as evidenced by an infiltrating lesion in the left lower lung on a chest radiograph. Because leukocyte scintigraphy cannot detect the presence of a chronic inflammatory process in the absence of acute inflammatory cells, the patient's abscesses in the left hip and the left pelvis did not localize Tc-99m HMPAO-labeled neutrophils. The cold lesion in the left hip area was most likely caused by the lesion in the reticuloendothelial system (bone marrow); the unidentifiable pelvic lesion was related to the area(s) outside the reticuloendothelial system. In interpreting a labeled leukocyte image, clinicians should be alert to the stage (chronic or acute) and location (regardless of whether in the reticuloendothelial system) of infectious lesion(s). In this patient, a wide spectrum of manifestations was evident on leukocyte scintigraphy.     

Improvement of the merthiolate-iodine-formalin (MIF) fecal technique for hookworm, Trichuris trichiura, and Ascaris lumbricoides eggs

A patient with a history of total thyroidectomy for papillary carcinoma showed a solitary hot spot in the chest on post-therapy radioiodine imaging. Subsequent evaluation demonstrated that this lesion was a primary squamous-cell lung cancer. Our case illustrates a rare but important differential diagnosis from lung metastasis of thyroid cancer in 131I scintigraphy. Alternatively, this "aberrant uptake" might be a rather common phenomenon for lung neoplasms, although the underlying mechanism is not yet known. Future experimental studies might lead to a new application of radioiodine imaging in pulmonary oncology.     

Effect of magnetic stimulation on the contractile activity of the rectum in the dog

A 64-year-old male complained of right hypochondralgia and was admitted to our hospital. A large tumor (10 x 15 x 10 cm) of the right diaphragm was detected involving the middle and lower lobe of the lung. Microscopic and immunohistochemical examinations showed that bronchiolo-alveolar cell carcinoma was interposed in the sarcoma-like lesion, and this tumor was diagnosed as a so-called carcinosarcoma of the lung.     

The arthroscopic appearance of lipoma arborescens of the knee

March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not appear to be specific for bronchiolitis obliterans, it may be of value in suggesting the diagnosis of early bronchiolitis obliterans in lung transplant. HRCT should be used in all patients with bronchoscopic diagnosis of bronchial complication to study the lesion and its mediastinal spread.     

Abdominal sonography for the diagnosis of bowel obstruction

Minimally invasive thoracoscopic staging for lung cancer was compared with re-staging by open thoracotomy in seventeen patients to evaluate whether videoimaged thoracoscopic staging was accurate. Seventeen patients underwent thoracoscopic staging initially with a closed videoimaged technique. These same patients then underwent an open thoracotomy and re-staging with a therapeutic resection for lung cancer. All patients underwent pleural evaluation and biopsy if indicated, thoracic hilar and mediastinal lymph node sampling, and then resection of the parenchymal lesion via a wedge resection, lobectomy or pneumonectomy. There was complete TMN stage correlation between the closed videoimaged thoracoscopic and open thoracotomy techniques. This preliminary study suggests minimally invasive videoimaged thoracoscopic staging is an accurate method to assess the stage of lung cancer to guide rational management.     

Human herpesvirus 6 infection as a risk factor for the development of severe drug-induced hypersensitivity syndrome

OBJECTIVES: To test suitability of radiographic evaluation of lung lesions as a substitute for lung lesion scores derived by examination at necropsy in challenge-exposure models of bovine pneumonia. ANIMALS: 10 calves selected by body weight from 20 multiple-source male Holstein calves approximately 1 to 2 months old enrolled in a Pasteurella multocida challenge-exposure study. PROCEDURE: Calves were paired on the basis of weight and randomly assigned within pairs to vaccine or control (saline solution) group. By use of deep tracheal cannulation, calves were challenge exposed with a culture of virulent P multocida, observed for 10 days, euthanatized, and necropsied, and the lungs were scored for pneumonic lesions. Radiographic views of the lung fields of the calves were taken before challenge exposure and before necropsy and were evaluated for alveolar disease by a veterinary radiologist. Lung lesion scores were compared with radiographic evaluations. RESULTS: There was a strong and significant correlation (R2 = 0.91, P < 0.001) between results of the evaluation of postchallenge-exposure radiographs and necropsy results. There also was also strong and significant correlation (R2 = 0.90, P < 0.001) between evaluation of the prechallenge-exposure radiographs and necropsy results. CONCLUSIONS: Radiographic evaluation of lung lesions correlates well with lung lesions found at necropsy. The findings emphasize the need for caution in interpreting the results of challenge-exposure studies of bovine respiratory tract disease in which small numbers of calves are studied.