Surgical treatment of lung cancer with chest wall invasion

From January 1986 to May 1998, 45 lung cancer patients with chest wall invasion (P3) underwent resection (40 male, 5 female), (median age 63.2 yrs (30-79)). Histological types were squamous cell carcinoma in 20, adenocarcinoma in 14, large cell carcinoma in 7, adenosquamous cell carcinoma in 2, and unknown in 2. Operative methods of lung resection were total pneumonectomy in 2, bilobectomy in 3, lobectomy in 38, and partial lung resection in 2. Resection was regarded as complete in 35 and incomplete in 10 patients. Thirty one patients had negative lymph nodes (N0), 9 had peribronchial or hilar lymph node metastases (N1), and 5 had mediastinal lymph node metastases (N2). The extent of tumor invasion to chest wall was P3a (invasion within parietal pleura) in 11, P3b-c (invasion to intercostal muscle) in 16, P3d (invasion to rib) in 18, patients. 5-year survival rate was totally 19.7%. Cisplatin based chemotherapy and concurrent thoracic radiation following surgery (CCRT) was performed in latest nine P3d cases. Partial response was observed in 5 of 9 cases (response rate 56%) and viable tumor cell in the primary site was not seen histologically in 5 of 9 cases. Three year survival rate was 46.9% for CCRT(+) 11.1% for CCRT(-). Acturial 5-year survival rate in P3a-d was 19.76%. P3d cases had poor survival, but CCRT improved prognosis of P3d cases.     

Surgical treatment for primary cardiac malignant lymphoma

A 60-year-old woman who complained of palpitation was diagnosed as ventricular tachycardia on electrocardiography and admitted to our hospital. The ultrasonic cardiography showed cardiac tumor in right ventricle and right atrium. Due to the obstruction of the right ventricle inflow by the tumor, we immediately performed resection of cardiac tumor and repair of right ventricle wall under cardiopulmonary bypass. The tumor was diagnosed as malignant lymphoma by pathological examination for surgical specimen of tumor. After operation her general condition was good, but residual cardiac lymphoma developed large size. We performed radiation therapy for cardiac lymphoma. Therefore the lymphoma was reduced to minimum size. Six months after operation metastatic malignant lymphoma appeared at whole body. So we performed chemotherapy for reduction of systemic malignant lymphoma. At first the chemotherapy was very effective. But metastasis spread rapidly and effectiveness of chemotherapy reduced. Thirteen months after operation she died for respiratory distress, probably due to metastatic brain tumor.     

Management of primary chest wall tuberculosis

The elderly are persons over age 65, now comprising 12% of our population. The normal elderly function normally both in their self care, and also in their social activities of daily living, which we tabulate. The current terms for the normally functioning elderly who show only mild psychological deficits are age-associated memory impairment and age-related cognitive decline, which we define, criticize and tabulate. The psychological deficits of the elderly consist of mild generalized slowing and inaccuracies compared to normal young persons. These deficits are measured by objective psychological tests which mimic real daily living situations--the name-face test, fire alarm test, two delayed recall tests, misplaced objects test, shopping list test, and digit symbol test, which we describe. A longer early formal education is preventive of mental dulling during normal aging. Treating using overlearning, by cognitive training, is significantly beneficial.     

Radiation-induced malignant mesenchymoma of the chest wall following treatment for breast cancer

21 years after radiotherapy for breast cancer, a 63-year-old woman developed a malignant mesenchymoma of the chest wall. The total irradiation dose was 132 Gy. The first clinical symptom of this second malignancy was a slight irregular calcification around the implanted silicon protheses observed in a conventional chest X-ray. Radiation-induced sarcoma is a very rare complication of radiotherapy. In cases of chest wall calcification after radiation therapy further investigation should be carried out, because some patients with radiation-induced sarcoma could be saved, if an early diagnosis is reached.     

Recurrent malignant acrospiroma. Treatment by chest wall excision

Malignant acrospiroma is an uncommon tumor of the eccrine sweat gland. In contrast to its relatively more common benign counterpart, malignant acrospiroma is highly invasive, often with significant lymphatic and distant metastasis. The establishment of this diagnosis is difficult on both clinical and histopathologic grounds. After diagnosis, wide surgical excision is warranted to completely extirpate these lesions. We report the case of a 66-year-old female with a recurrent malignant acrospiroma. This patient's tumor was removed by wide radical resection, including chest wall excision, followed by reconstructive surgery and radiotherapy. After 16 months there is no evidence of local recurrence or distant metastasis.     

Surgical treatment of aortic rupture by blunt chest trauma

During a ten-year period, seven patients with traumatic rupture of the thoracic aorta were operated upon. Four patients of them were operated within one week. Chest X-rays and chest computed tomography could not always reveal the exact diagnosis of aortic rupture. Intravenous digital subtraction angiography was useful to confirm the diagnosis. The repair of the rupture was accomplished with the adjunct of left heart bypass using Bio-pump, which was useful to reduce the bloodloss with a limited systemic heparinization. Another three patients were diagnosed to have chronic post-traumatic aneurysm of the thoracic aorta and underwent aortic replacement with prosthetic graft. One of seven patients died at seventh postoperative day because of cerebral contusion, the associated lesion of an automobile accident. It is stated that the aortic rupture is immediately fatal in approximately 80% of individuals, and most of remaining 20% die within 2 weeks unless the lesion is repaired. Therefore immediate operative intervention is recommended when the aortic rupture is strongly suspected. Chronic post-traumatic aneurysms should be resected because it has become apparent that the majority of patients with this lesion will develop complication, such as sudden rupture.     

Surgical treatment of primary neurogenic mediastinal tumors

In the years 1968-1989 out of 300 patients with surgically treated mediastinal tumors in 63 (21%) they were of neurogenic origin. Eighteen of these (29%) proved to be malignant. These tumors occurred in 23 males and 40 females, age range 14 months-67 years (mean 36 years). In all 45 patients with benign tumors and in 12 (66.7%) with malignant tumors the tumors were totally resected. In 4 patients the tumor was only partially resected in further two only a biopsy of the lesion was taken. During postoperative period one patient with a malignant tumor died. Ten (71.4%) patients survived 5 years with malignant lesions, while only 8 (61.5%) survived ten years. All patients that underwent resection of the benign tumor survived 10 years.     

Surgical treatment of primary epicardial tumors]

Seven cases of primary epicardial tumors of 3200 cardiac operation cases were diagnosed definitely, including benign in 5, malignant in 2. Among them, readical resection was performed in 5 cases, partial resection in 1, and decompression of pericardium in 1. Data of this series were often regarded as tuberculous pericarditis or others incorrectly. UCC, CT and MRI were helpful in diagnosis. The authors emphasize early surgical treatment as soon as possible and using the different methods of operation whether to utilize cardiopulmonary bypass or not according to site, size and characteristics of tumors to resect tumors, if necessary, reconstruction the heart wall to maintain blood follow dynamics. The prognosis of the diseases was related to the pathology and the area of invasion of tumors.     

Surgery of chest wall deformities

The effect of melatonin (MEL) on the nephropathy and the oxidative stress induced by a single and high dose of Adriamycin (AD) has been studied in Wistar male rats. MEL (50 microg/kg/day) was injected intraperitoneally 3 and 7 days, respectively, before and after AD injection (20 mg/kg i.p.). Trunk blood was drawn and triglycerides, total cholesterol, phospholipids, high-density lipoprotein cholesterol, urea, creatinine, total protein, lipoperoxides, and reduced glutathione (GSH) levels and catalase activity (CAT) were determined in serum. In kidney homogenates, lipoperoxides, GSH, and CAT were measured as well as total protein in urine. AD administration resulted in hyperlipidemia and high-grade proteinuria and a marked increase in serum lipoperoxides, urea, and creatinine. In the kidney, the increase in lipoperoxides was accompanied by a significant decrease of GSH and CAT. The efficiency of MEL was specially remarkable in restoring GSH, CAT, and proteinuria to the levels of controls. These results confirm the involvement of free radicals in the pathogenesis of nephrotoxicity induced by AD. Likewise, they show the high antioxidative power of MEL and its marked effect on the prevention and suppression of this nephropathy.     

Imaging and pathological features of primary malignant rhabdoid tumours of the brain and spine

In this article two cases of primary malignant extrarenal rhabdoid tumour are described. In the affected children the brain and the spinal cord were the primary sites of origin of the tumour. The imaging findings are presented and the pathology discussed. Although the imaging features are non-specific, rhabdoid tumour should be included in the differential diagnosis of childhood intracranial and spinal neoplasms.     

Surgical treatment of primary lung cancer in women

Among 1906 lung carcinoma cases treated in the clinic up to 1975 inclusive, there were 182 women (9.5%). The comparative study of 84 women and 927 men operated upon, proved the operability and resectability in women (46.1% +/- 3.7 and 34.1 +/- 3.5) to be lower than in men (53.8% +/- 1.2 and 46.3% +/- 1.2). Peripheral cancer was found in 28.6% +/- 3.3 of women and in 23.6% +/- 1.0 of men. The main histological form of the tumor in women was glandular carcinoma (45.2% +/- 6.3) and in men squamous cell carcinoma (62.2% +/- 1.7). The lobectomy was the most common of radical operations performed in women (58.1% +/- 6.2); in men it was the pneumectomy (65.1% +/- 1.7). In 6 of 26 women suffering from neoplasm of stage III the vast pneumectomy was carried out; in men this operation constituted 46.1% of all cases of total lung removal. The immediate results in women (complications--14.3% +/- 8.8 and mortality--2.4% +/- 1.7) are better than in men (24.1% +/- 1.4 and 9.3% +/- 1.0). The five-year follow-up showed the survival in women to be 39.1% +/- 10.6 and in men 28.3% +/- 3.0.     

Myositis ossificans of the chest wall

We report the unusual case of a young man with progressive pain in the thoracic wall. The radionuclide bone scan revealed an increased uptake, and the bone roentgenogram, a calcified soft-tissue mass. Based on computed tomography findings, biopsy was avoided, and evolution was favourable for myositis ossificans. Although rare, myositis ossificans is one of the potential causes of thoracic pain, not to be mistaken for a malignant or infectious lesion.     

Primary amyloidoma of the chest wall

Primary amyloidoma of the chest wall presents as an aggressive tumor that causes local destruction. It is best treated with wide local excision and reconstruction as required, which usually is curative. A search for occult systemic disease also is recommended.     

Mesenchymal hamartoma of the chest wall

Reference values are essential for the interpretation of cytological findings in bronchoalveolar-specimens from healthy and diseased pigs, and also for studies on local immunity of the porcine lung. Values were calculated from 164 piglets out of six closed herds based on cellular bronchoalveolar lavage (BAL) data. The piglets were preselected by criteria of pulmonary health and total as well as differential cell count were performed. The values established were: total cell count 1-4.5 Giga litre-1, alveolar macrophages 90-99 per cent, lymphocytes 0-9 per cent, polymorphonuclear neutrophils 0-8 per cent, blastocytes 0-2 per cent, polymorphonuclear eosinophils and basophils 0-1 per cent.     

A case of T-cell malignant lymphoma developing in the chest wall of chronic pyothorax after artificial pneumothorax

A 66-year-old man, with a past history of artificial pneumothorax for pulmonary tuberculosis at the age of 17, was admitted to our hospital because of progressive left precordial pain and left anterior chest wall tumor. Because of chronic pyothorax complicated by a tumor suggested by imaging diagnosis, surgery was performed for the purpose of fenestration. A diagnosis of diffuse large cell T-cell malignant lymphoma was made by the biopsy taken at surgery. Postoperatively the patient received 6 courses of combination chemotherapy with CHOP, the course turned favorable. The left precordial pain and tumor disappeared. The patient is doing well at 11 months postoperatively. Recently, cases of malignant lymphoma developing in the chest wall of chronic pyothorax have been increased and the majority of cases of the malignant lymphoma is B-cell type. T-cell type is rare. Follow-up of chronic pyothorax's patients necessarily are attentioned on the developing of the malignant lymphoma.     

Malignant tumors invading chest wall: treatment with CT-directed implantation of radioactive seeds

Computed tomography (CT) was used to direct permanent implantation of radioactive iodine-125 seeds in two patients with unresectable lung cancer and in one with recurrent breast cancer invading the chest wall. An average of 60 seeds were implanted, with a mean total radioactivity of 35.6 mCi (1,317 MBq). Tumor coverage was adequate and pain relief was good in all patients. One patient had histologically documented complete response and another had CT-documented partial response.     

Respiratory prognosis in chest wall diseases

Intracerebroventricular administration of galanin (GAL) potently evoked growth hormone (GH) secretion in conscious male rats. Pretreatments with neostigmine and cysteamine blunted the GAL-induced GH secretion. Pretreatment of animals with a specific anti-somatostatin serum significantly inhibited the GAL-induced GH secretion. On the contrary, GH-releasing hormone-induced GH secretion was significantly enhanced with cysteamine and anti-somatostatin serum. These results suggest that somatostatin is involved in GAL-induced GH secretion in rats.