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Query: UMLS:C0242379 (lung cancer)
 71,905 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute adrenal insufficiency is an uncommon complication of lung cancer and adrenal metastasis resection. Diagnosis is difficult to establish but an early recognition and treatment may be life-saving. A 55-year-old man underwent right upper lobectomy and adrenalectomy for lung carcinoma with right adrenal metastasis. Anaesthesia was obtained with propofol, alfentanil, atracurium and isoflurane. Blood pressure remained stable throughout surgical procedure and blood loss was about 3,000 ml. Several hours after the end of the procedure which was uneventful the circulator status worsened. The blood pressure was initially controlled with 500 ml of gelatin. External blood loss was about 200 ml. Clinical examination, chest X-ray and ECG were normal. Postoperative laboratory data showed a serum sodium at 134 mmol-1.l-1 and a serum potassium 5.1 mmol.l-1; haemoglobin concentration was 93 g.l-1. Arterial blood gas analysis, with a 5.1.min-1 nasal O2 flow showed a PaO2 at 108 mmHg, a PaCO2 at 30 mmHg and a pH at 7.44. Twelve hours later, a transient cardiac arrest occurred which responded to fluid load, dopamine and dobutamine. Six hours later, the patient went in ventricular fibrillation responding to an external electric countershock. No change in clinical status was noticed, except hyperthermia at 39.5% degrees C. Serum potassium concentration before cardiac arrest was 4.7 mmol-l-1. Main considered diagnoses were septic shock and acute adrenal insufficiency. Antibiotics (imipenem, amikacin and vancomycin) and hormonal treatment (hydrocortisone 200 mg.day-1), after blood samples had been obtained for bacteriological and hormonal examinations. The patient's condition improved dramatically within 48 hours. Shock was under control, dopamine and dobutamine were rapidly discontinued.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative acute adrenal insufficiency]. 801 76

Between April 1992 and April 1993, we performed fifty-four mediastinal biopsies in 51 patients with a mediastinal mass. Nine of these had lung cancer with mediastinal lymphadenopathy, and the remaining 42 had various primary mediastinal lesions. We have performed twenty video-assisted thoracic surgical procedure, twenty-six mediastinoscopies, and eight anterior mediastinotomies. In 3 patients the diagnosis was not obtained by mediastinoscopy, and video-assisted thoracoscopy was performed. We conclude that mediastinoscopy is indicated for the majority of lesions involving the peritracheal space. Restaging of lymphoma and highly infiltrative lesions are better managed by video-assisted thoracic surgery. Anterior mediastinotomy is indicated when feasible under local anesthesia for tumors infiltrating the anterior chest wall. In all other cases video-assisted thoracic surgery is preferable because it allows removal of large tissue biopsy specimens and even resection with wide surgical exposure and low operative trauma.
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PMID:Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy. 816 55

Hugh Morriston Davies (1879-1965), long before anybody else, performed the first anatomic dissection lobectomy for a tumor of the lung in 1912. By replacing the hilar mass-ligation-suture technique, he was decades ahead of his time, and had his patient not died 8 days after the operation, he would have preceded Evarts Graham's first lung resection for cancer by 21 years! An all-around chest physician and surgeon in one, he had introduced chest radiography and positive-pressure intratracheal anesthesia the year before, thus making the diagnosis and operation of this lung cancer possible. He concluded that lung cancer was accessible to surgical removal on condition of an early diagnosis. By destiny a surgeon as well as a physician, Morriston Davies was probably the earliest advocate of interdisciplinary teamwork in thoracic medicine.
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PMID:Hugh Morriston Davies: first dissection lobectomy in 1912. 816 19

A study was carried out to determine the effects of transfusion with either autologous or homologous blood in 35 patients with lung cancer undergoing lung surgery. The patients were randomly allocated to two groups, "allo" receiving homologous blood (n = 10), and "auto" receiving autologous blood only (n = 13). A third control group included the patients (n = 12) who had not required any blood. In patients of "auto" group, two blood removals of 7 ml.kg-1 each were performed, provided their haemoglobin concentration was over 110 g.l-1 and their haematocrit over 34%. The following parameters were studied at t-1 (the day of inclusion), t0 (just before surgery and transfusion), t1 (one week after surgery), and t2 (one month later): haematocrit and haemoglobin concentration; IgG, IgA and IgM concentrations; polymorphonuclear and neutrophil leucocyte and lymphocyte numbers, lymphocyte subpopulations (CD4/CD8), activated natural killers (NK), polymorphonuclear leukocyte chemotaxis and chemoluminescence. Anaesthesia and surgery initiated initiated an early decrease in immunity in all three groups. The immune profile, and its time course in patients who received autologous blood only was similar to that of those who were not transfused at all. On the other hand, homologous blood transfusion seems to modify the recipient's non specific immune system. In group "allo", a decrease occurred in the number of auxiliary lymphocytes CD4, an increase in suppressor lymphocyte numbers CD8, with an increase in the CD4/CD8 ratio, and no increase in NK activity. These data suggest that autologous transfusion is well tolerated in cancer patients undergoing surgery.
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PMID:[Comparative study of immunologic consequences of autotransfusion and homologous transfusion in lung cancer surgery]. 825 Mar 62

Two-dimensional Doppler echocardiography was used as an intraoperative cardiac function monitor in anesthetic management of a 79-year-old male with hypertrophic obstructive cardiomyopathy (HOCM) who underwent pulmonary lobectomy for lung cancer. Circulatory collapse occurred after thoracic epidural anesthesia (TEA), and was aggravated with following induction of general anesthesia. The collapse did not improve with phenylephrine nor atropine and necessitated ethylephrine and dopamine. During the above course, left ventricular outflow tract pressure gradient measured with continuous wave Doppler method was almost in proportion to cardiac output measured with thermo-dilution method. This means that TEA and the administration of inotropics did not worsen the left ventricular outflow tract obstruction. Left ventricular filling property estimated by trans-mitral flow velocity spectra improved when hemodynamics was stabilized with continuous infusion of dopamine, while it had been impaired during preoperative period and at the beginning of anesthesia. Our observation suggests that TEA for HOCM patient is a relative indication because it may exert negative inotropic effect, and that careful titration with inotropics is not contraindicated when undesired cardiac depression is proved by echocardiography.
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PMID:[Echocardiographic observation of intraoperative circulatory collapse in a patient with hypertrophic obstructive cardiomyopathy]. 830 35

The treatment of 37 consecutive cases of symptomatic malignant pericardial effusion over a period of 13 years was retrospectively analyzed. The most common diagnoses were lung cancer (59%) and breast cancer (11%). In the most recent 4 patients, the Denver pleuroperitoneal shunt was used to drain the pericardial effusion into the peritoneal cavity. In each case, the procedure was performed under local anesthesia, and the patient was discharged 2 to 4 days later without complications. Three of the patients subsequently died of the disease process without evidence of cardiac failure or tamponade during 6-month follow-up. The more traditional means of pericardial drainage, the subxiphoid approach (14 patients) and the anterior thoracotomy approach (19 patients), were associated with higher postoperative morbidity (21% and 53%, respectively) and mortality (7% and 42%, respectively). Because of the small number of patients treated by pericardioperitoneal shunting, a significant difference was demonstrated only in the length of hospital stay (shunt, 2.8 +/- 0.5 days; subxiphoid, 11.2 +/- 4.6 days; thoracotomy, 14.9 +/- 6.1 days). Median survivals were essentially the same (shunt, 3.5 months; subxiphoid, 2.7 months; thoracotomy, 1.2 months). It is apparent that the pericardioperitoneal shunt, although a much simpler procedure, can accomplish similar palliation effectively in the treatment of malignant pericardial effusion.
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PMID:Pericardioperitoneal shunt: an alternative treatment for malignant pericardial effusion. 831 86

An ultrasonic bronchoscope has been newly developed for diagnosis and lymph node staging in the hilum and mediastium. The instrument comprises an Echo-camera, SSD-630 (Aloka), and a transbronchial ultrasonic probe similar to the currently used videobronchoscope. The scope is equipped with an ultrasonic transducer in its tip. The maximum diameter of the probe head is 6.3 mm and that of the transducer, 5.0 mm. The frequency employed is 7.5 Megahertz (MHz) and the direction of scanning is parallel to the bronchoscopic axis. The device can easily be introduced into the lobar bronchus under topical anesthesia in a similar procedure to that used for routine videobronchoscopy. The location of the transducer in the airway is confirmed by monitoring endoscopic images on a TV monitor screen. With the device, 25 patients, who had given their consent for the ultrasonographic study beforehand, were examined during the two-month period, January and February, 1992. Vessels such as the thoracic aorta, pulmonary artery and truncus brachiocephalicus were good landmarks for diagnosis. Lung cancer was detected in five patients by biopsy, three malignant lesions in the hilum were diagnosed by videobronchoscopy while two malignant lesions in the periphery were confirmed by bronchoscopic ultrasonography as anterior mediastinal lymph node swellings.
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PMID:Bronchoscopic ultrasonography in the diagnosis of lung cancer. 845 39

The exact indications for computed tomography (CT) of the thorax and mediastinoscopy (MS) in lung cancer still remain incompletely defined. The present study was designed to establish a standard approach to cervical MS for otolaryngologists, who in Denmark are traditionally involved in the staging of non-small-cell lung cancer (NSCLC). Sixty-four potentially operable patients with NSCLC underwent thoracic CT prior to bronchoscopy and cervical MS. Cervical MS alone established the histological diagnosis in 20% of the patients. In diagnosing lymph node metastases in the superior mediastinum, a criterion of 10 mm for abnormal enlargement resulted in an overall sensitivity and specificity of mediastinal CT of 81 and 84%, respectively, and the overall false-negative and false-positive rates appeared to be 10 and 29%, respectively. It could be demonstrated that mediastinal lymph nodes in patients with mediastinal metastases were significantly larger than mediastinal lymph nodes in patients without metastases. No clinicopathological characteristics could be identified to influence the accuracy of CT, except for the finding that the rate of false-negative mediastinal CT was significantly higher in patients with right-sided than in patients with left-sided lesions. It is concluded that because of the relatively low sensitivity and specificity of mediastinal CT, cervical MS remains essential in the evaluation of patients with presumed or verified NSCLC and that cervical MS, in experienced hands, is a safe and accurate procedure. For Danish otolaryngologists, the strategy of routine cervical MS, performed under general anaesthesia in the same stage as bronchoscopy, is advocated as a standard approach to mediastinal assessment for the staging of NSCLC. However, thoraco-abdominal CT is advocated for all patients with NSCLC, in whom operation is contemplated, as a supplementary investigation after other routine diagnostic and staging procedures, including cervical MS, have been carried out.
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PMID:Mediastinal staging of non-small-cell lung cancer: computed tomography and cervical mediastinoscopy. 858 82

Bupivacaine 0.25% encapsulated by multilamellar liposomes was administered epidurally to a patient suffering pain associated with lung cancer and the effect compared with a plain bupivacaine solution of the same concentration. Complete analgesia was produced for 4 h with the plain solution and 11 h with the liposomal formulation. No motor blockade or haemodynamic instability was observed with the liposome-associated bupivacaine.
Anaesthesia 1996 Jun
PMID:Use of liposome-associated bupivacaine in a cancer pain syndrome. 869 14

Recent improvements in endoscopic technology and surgical techniques have widened the application field of video-assisted thoracoscopy (VAT). We report our personal experience in 14 male patients (mean age: 67 years, range: 55-73 years) in whom one or multiple indeterminate contralateral lung nodules were found during bronchogenic carcinoma staging and then surgically resected with VAT. All patients underwent volumetric CT of the chest. Sixteen lung nodules were detected contralateral to the neoplasm; their mean diameter was 5 mm (range: 2-10 mm). The mean distance between pleural surface and lung nodule was 8 mm. All patients had primary lung cancer (3 central and 11 peripheral lesions), histologically confirmed by bronchoscopic or percutaneous CT-guided biopsy. None of them had any contraindication to surgery because of extrathoracic pathologic conditions. VAT was performed as normal, under general anesthesia, with assisted ventilation with a double-lumen endotracheal tube and using a percutaneous mechanical stapler. The nodules were easier to identify using a skin reference point corresponding to the parietal projection of the nodule, positioned with CT before surgery. Surgery lasted 58 minutes on the average (range: 30-120 minutes). In all patients VAT was successful in resecting the nodule. In 9 patients a metastasis from a contralateral lung cancer was found: 4 adenocarcinomas, 4 epidermoid carcinomas and 1 small cell carcinoma. In the remaining 5 patients, VAT-resected lung nodules were of chronic inflammatory nature. The latter patients underwent definitive surgery of the primary tumor (2 adenocarcinomas, 2 epidermoid and 1 large cell carcinomas) ten days later (range: 9-30 days). There were no major complications but a prolonged air leak in one patient, which needed drainage to be maintained for 5 days. Presently, VAT permits an atypical resection, avoiding the morbility of thoracoscopy and thus represents a mandatory technique in selected patients amenable to definitive surgery.
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PMID:[Spiral computerized tomography and videothoracoscopy in the assessment of contralateral nodular lesions in patients with bronchogenic carcinoma]. 883 Mar 56


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