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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study of 595 patients treated by the Thoracic Surgical Unit (TSU) at the University College Hospital (UCH), Ibadan between July 1975 and December 1977 was carried out to determine the pattern of thoracic surgical diseases in Nigeria and to prove or disprove the rarity of certain cardiopulmonary diseases in tropical Africa. This review shows that pyogenic infections of the lung and pleura constitute the largest percentage (38.5) of the thoracic surgical diseases in Nigeria. Although pulmonary tuberculosis accounts for only 23.4 percent of our total inpatient load, it constitutes about 60 percent of our outpatient clinic practice. Cardiovascular diseases form 12.9 percent, notably congenital and acquired valvular heart diseases. An interesting finding was the occasional association of pyomyositis with pyogenic pericarditis and empyema thoracis. This triad is being investigated. Chest trauma was the most common thoracic surgical emergency accounting for 9.2 percent of the total thoracic surgical pathology. The most common causes of dysphagia are strictures from corrosive esophagitis, achalasia, and carcinoma of the esophagus. Present experience confirms the rarity of hiatus hernia, reflux esophagitis, atherosclerotic cardiovascular disease, and, perhaps, carcinoma of the lung among Nigerians.
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PMID:Pattern of thoracic surgical diseases in Nigeria: experience at the University College Hospital, Ibadan. 70 99

A 68-year old man experienced a progressive proximal tetraparesis with anhidrosis and a single episode of horizontal diplopia before presenting exertional dyspnea; pulmonary investigations revealed a small cell carcinoma of the lung. Clinical and electrophysiological investigations with abnormal SFEMG, repetitive stimulations and autonomic assessment pointed to a pre-synaptic neuromuscular dysfunction compatible with a Lambert-Eaton syndrome. Antibodies to acetylcholine receptors and calcium channels were negative. Thoracic radiotherapy combined with chemotherapy produced marked improvement: repeated electrophysiological evaluations showed a strong correlation between median nerve CMAP amplitude and clinical course. This case prompted us to discuss current concepts of pre-synaptic dysfunction, and paraneoplastic syndrome, and to review therapeutic strategies, in the light of recent studies of Lambert-Eaton syndrome.
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PMID:[Lambert-Eaton myasthenic syndrome. Physiopathological aspects and therapeutic modalities]. 136 69

The first description of multiple primary tumors of the lung was reported by Billroth in 1889. In a series of 448 thoracotomies for lung cancer in the Department of Thoracic Surgery of the Geneva Cantonal University Hospital, 11 were performed in 9 men and 2 women for double metachronous lung tumors. The tumor-free time interval between the operations ranged from 9 months to 15 years, with a mean of 61 months. The tumor was in the contralateral lung in 4 patients and in the ipsilateral one in 7 cases. Pathological examination demonstrated a different histology in 4 patients (36%). Eight of the 11 patients had resectable disease. Twenty-five percent of the patients survived without recurrence for 5 years. Four patients (36%) died within one year of diagnosis of the second tumor; three of these patients did not have a resectable second tumor. The risk of development of a second primary lung carcinoma is low, less than 1-2.1% in some series, 2.7% in our series. The survival is fairly similar to that of primary lung carcinomas in general. Surgery offers the best treatment for these tumors, which is why resection of lung carcinomas should be as limited as possible. Long-term follow-up for more than 5 years and suppression of carcinogenic factors are therefore justified.
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PMID:[Multiple metachronous lung tumors. Metastases or second primary tumor]. 201 38

A 55-year-old man was diagnosed as having limited disease (T2N2M0, stage III) of small-cell carcinoma of the lung. He underwent radiation therapy (60 Gy in 30 fractions) in addition to combination chemotherapy, resulting in complete response with advantage for irradiation. Relapse in the primary site was seen three years after completion of the initial treatment. As a result, retreatment was started using radiation therapy (50 Gy in 25 fractions) with chemotherapy. The tumor almost disappeared again. Subsequently, cerebral metastasis was observed in the fourth year, indicating clinical and prognostic significance. Thoracic irradiation contributed to prolonged survival in this case. The most effective manner of combining irradiation and chemotherapy and the most efficacious doses were discussed.
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PMID:[Small-cell carcinoma of the lung relapsing at the primary site three years after radiation therapy with chemotherapy]. 302 54

Although CT has assumed a major role in the preoperative evaluation of the mediastinum in patients with lung carcinoma, there is no consensus as to its accuracy or efficacy in this setting. A potential source of CT error is inaccurate detection or sizing of lymph nodes in particular mediastinal locations because of inadequate contrast with surrounding tissue or partial volume effects. We imaged five cadavers with CT and then meticulously dissected the mediastinal nodes. The nodes were measured and categorized by using the lymph node mapping scheme of the American Thoracic Society. The short axis nodal diameter was the best CT predictor of nodal volume. Excellent correlation was found between CT and autopsy for lymph node detection in right-sided mediastinal lymph nodes; poorer CT/autopsy correlation was found for left-sided lymph nodes, especially in the lower left peribronchial region. These findings suggest that CT may be less accurate in identifying left-sided mediastinal metastases.
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PMID:Mediastinal lymph node detection and sizing at CT and autopsy. 348 47

Between 1979 and 1984, mediastinoscopy was performed on 1,000 of the 1,500 patients admitted to the Thoracic Surgical Service of the Toronto General Hospital with the diagnosis of carcinoma of the lung. In 144 cases, concomitant anterior mediastinoscopy was also performed. Abnormal mediastinal nodes were found in 296 (29.6%). The overall complication rate was 2.3%, with no deaths. Mediastinoscopy revealed diseased nodes in 24% of patients with squamous cell carcinoma, 29% with adenocarcinoma, 54% with small cell undifferentiated carcinoma, 31% with large cell undifferentiated carcinoma, and 12% with bronchoalveolar carcinoma. Abnormal mediastinal nodes were found with equal frequency in right- and left-sided tumors and occurred in 31% of tumors in the main bronchus, 25% of upper lobe tumors, and 17% of lower lobe tumors. Of the 704 patients having negative results of mediastinoscopy, 590 were subjected to thoracotomy. Ninety-three percent underwent resection (85% curative, 7% palliative) and 7% had unresectable tumors. Of the resections, 20% were pneumonectomies. At thoracotomy, 52 of the 590 patients with negative mediastinoscopic results were found to have abnormal mediastinal nodes. Sixty-two of the 296 patients with positive results of mediastinoscopy were selected for thoracotomy. Eighty-six percent had resectable lesions (67% curative, 18% palliative) and 14% unresectable. The pneumonectomy rate in this group was 35%. These current data support our previous opinion that routine mediastinoscopy can be done with negligible morbidity and provides essential information for the classification and management of cancer of the lung.
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PMID:Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung. 394 59

A total of 304 patients with limited small-cell carcinoma of the lung were treated with a combination of cyclophosphamide, Adriamycin (Adria Laboratories, Columbus, Ohio), and vincristine (CAV) and elective brain irradiation (3,600 rad TD in 14 fractions). The patients were randomized to either receive or not receive thoracic irradiation (4,000 rad TD, split course). Of the 304 patients, 291 were eligible for the study. Two hundred eighteen (75%) were completely evaluable. In each group, 81% of the patients had a Karnofsky index of 80% or higher and 14% had supraclavicular or scalene lymph nodes. Patients treated with CAV and no thoracic irradiation had a complete response (CR) of 48%, in contrast to 63% for those receiving chest irradiation (P = .05). In the first group, the complete and partial response rate was 70%; in the second, 80%. The median survival for the eligible patients treated with CAV and brain radiation therapy was 49 weeks; for those treated with the same regimen plus thoracic irradiation, the median survival was 60 weeks. The actuarial two-year tumor-free survival is 19% in the first group and 28% in the second group. The median survival for the responders in the CAV plus brain irradiation group was 57 weeks and for those receiving thoracic irradiation, 78 weeks (P = .12). Thoracic failure was 52% in patients not treated with thoracic radiation therapy v 36% in those receiving it (P = .06). The distant metastases incidence was 23% in patients not treated with thoracic radiation and 35% in patients treated with thoracic radiation. Hematologic toxicity was comparable in both groups; 30% of the patients had moderate to severe granulocytopenia and 6%, low homoglobin. Two toxicity-related deaths occurred (one in each group). Moderate gastrointestinal toxicity was noted in 41% and severe in 16% of the patients receiving CAV and brain irradiation without thoracic radiotherapy v 44% and 20% in those irradiated in the thorax. Disease-free survival is enhanced in the patients receiving thoracic irradiation. More effective chemotherapy is critically needed to significantly improve overall survival. These preliminary results suggest that thoracic irradiation should be a primary component in the therapy of these patients, although this combined therapy is moderately toxic.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report. 609 55

118 patients with carcinoma of the lung seen in the Department of Cardiovascular and Thoracic Surgery, Tan Tock Seng Hospital, Singapore were followed for five years. The aim was to determine the survival of these patients in relation to the stage of the disease as well as the histologic type of carcinoma. 22 patients were in stage 1, 13 in Stage II and 83 in Stage III. Thoracotomy was performed in 62 patients and the rest had biopsy of distal lymph nodes. 43.3% of the carcinoma were squamous cell, 25% adenocarcinoma, 27% large cell, anaplastic, 2.9% oat cell and 1.8% bronchoalveolar cell carcinoma. Survival of the patients were found to be closely related to stage of the disease but not with the histologic type.
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PMID:Primary carcinoma of the lung. 733 99

In this prospective study of 148 surgically treated patients with non-small cell carcinoma of the lung (NSCLC) who were followed for 5 to 7 years, we analyzed the prognostic value of mediastinal lymph node invasion (N2) and survival after 5 years depending on different characteristics. Forty-two (28.4%) patients were N2. Survival in this sample was 9%. Twenty-seven T2N2 patients (among whom survival was 13%) were selected from this group and classified according to whether lymph node invasion was intranodal (survival 39%) or extracapsular (survival 5%) (p < or = 0.05). We also evaluated the prognostic value of different ganglionic areas in accordance to the maps suggested by the American Thoracic Society (ATS). There were no survivors for areas 2, 8 and 9, and no patient with invasion of more than two areas lived more than 18 months. Significant differences in survival were found among patients with invasion of areas 10 and 11. We conclude a) that global analysis of N2 is of such little value in predicting survival that surgery is not justified unless screening criteria are applied; b) that extracapsular invasion rules out surgical treatment; c) that the prognostic value of ganglionic areas is not entirely clear, although the prognosis seems to be poorer for invasion of areas 2, 8 and 9 or invasion of more than 2 areas, and d) that invasion of area 10 would appear to be better classified as N2 than as N1.
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PMID:[The prognosis of mediastinal lymph node infiltration (N2) in patients with non-small-cell lung carcinoma (NSCLC) who have undergone curative treatment]. 802 86

Using the pre-therapy CT scans of 266 node positive non-small cell lung cancer patients, we analysed the lymphatic pathways and the incidence of lymph node metastases in regional lymph nodes (as described by CT criteria corresponding to the modified mapping scheme of the American Thoracic Society), in order to develop the target volume for curative irradiation treatment. Among the 105 patients with node positive left sided primaries, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 9.5%, and the incidence of involvement of the contralateral lymph nodes was 3.8%. The incidence of involvement of the contralateral hilar lymph nodes was 4.8%. Among the 161 patients with nodal positive right sided primaries, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 8.7% and the incidence of involvement of the contralateral lymph nodes was 1.8%. For this group of patients, the incidence of involvement of the contralateral hilar lymph nodes was 3.7%. All patients with involvement of the contralateral hilar lymph nodes died within 2.5 years of diagnosis. In the cases where there was involvement of the supraclavicular lymph nodes, the patients died within 1.6 years. Involvement of the ipsilateral and/or contralateral supraclavicular lymph nodes, and/or the contralateral hilar lymph nodes, is defined as N3 disease, and is included in Stage IIIb. No curative surgery is indicated for these patients. Why therefore should this group of patients be treated with curative intent by irradiation of the primary, ipsilateral and contralateral hilar lymph nodes, as well as mediastinal, ipsilateral and contralateral supraclavicular lymph nodes? The curative radiation treatment volume for lung cancer has to include the primary tumor and the ipsilateral hilar, and the low and high mediastinal lymph nodes, as is indicated for Stage I, II and IIIa disease.
Lung Cancer 1994 Jul
PMID:The lymphatic pathways of non-small cell lung cancer and their implication in curative irradiation treatment. 808 6


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