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Management of hemoptysis in a Third World city hospital: A retrospective study, Kathmandu, Nepal
138
Tubercle and Lung Disease: Supplement
503 ENDOBRONCHIAL INVASIVE THERAPY APPROACH AND FACILITIES PeSek, M., Bruha, F., Houdek, J.; Pulm. Dpt., Uni Hospital, Tr. E. BeneSe 13, Plzeri, CR
The autors present their 7 year experience with endobronchial miniinvasive therapy (EMIT). They have used 2 cryotherapeutic systems (liquid and N20), 2 lasers (with wavelengths of 1060 and 1320 nm), Laser interstitial hyperthermia, monopolar and bipolar electrodiathermia, high-dose afterloading and combinations of all of these to treat endobronchial obstructions. 95 patients were treated by 165 cryotherapy sessions, 50 laser coagulation sessions, 3 laser resections and 7 laserthermias. The desired effect wps not seen in 5 patients after cryotherapy, in 5 patients after laser therapy and in 1 after electrodiathermia. There were 6 minor complications 1 atelectasis, 1 small pneumothorax, 2 short-term bleeding, 2 short-term hypoxemia during the operation. All of the affected patients fully recovered. In an emergency, laser is the first choice. Howewer, in non emergent situations, softer modalities (cryodestruction, laserthermia) could be used as well. All methods mentioned alone could be used as complementary tools. Various complications of EMIT methods are sometimes more effective then any one of them. 504 LUNG CANCER IN YOUNG
ADULTS
Schoenfeld, N., Bender, J., Kaiser, D., Loddenkemper, R.; Chest Hospital Heckeshorn, Zum Heckeshorn 33, 14109 Berlin, Germany
Conflicting reports have been published on the incidence, prognosis, distribution of histologic type and stage of lung cancer in patients under age 40. We have therefore reviewed the data of 2628 lung cancer patients with definite histo- or cytopathologic diagnosis registered from 1986 in the Cancer Registry of the Chest Hospital Heckeshorn. 54 patients (2.1%) were younger than 40 years. Compared with older patients a higher proportion of patients under age 40 were female (48 vs. 27%). The distribution of cell type was significantly different from older patients (p< 0,001) with a higher proportion of adenocarcinoma (24154; 44 vs. 25 %) and carcinoid tumors (6/54; 11 vs. 1%) and a lower proportion of squamous cell (7/54; 13 vs.31%) and small cell carcinoma (6/54; 11 vs. 23 %). The distribution of tumor stages was also different (p = 0,02) with a higher proportion of stage I (17 vs. 11%) and stage IIIB (30 vs. 14%) in younger patients. KaplanMeier analysis revealed that survival of the younger or older group did not differ significantly for either all histologic types together (mean 569 vs.537 days) or nonsmall-cell cancer (494 vs. 542 days; n=41 and 1954, respectively). We conclude that even though patients under age 40 showed a significantly different distribution of histologic type and tumor stage, their prognosis was similar to the older patients in our series. 505 MANAGEMENT OF HEMOFTYSIS IN A THIRD WORLD CITY HOSPITAL: A RETROSPECTIVE STUDY, KATHMANDU, NEPAL van Kralingen, K. W., Zimmerman, M., Postmus, P. E.; Dept. Pulmonology, Free University Hospital, P. 0. BOX 7057, 1007 MB, Amsterdam, Holland
Massive hemoptysis as defined by blood loss greater than 6OOm1/24hr can carry a mortality of up to 85 % (Garzon et
al. Ann Surg 1972; 187: 267). We undertook a retrospective patient chart study to analyse underlying pathology, management and outcome of hemoptysis patients in a hospital with no thoracic surgical or embolisation facilities. The study group consisted of 63 patients (group I: 100 ml or less [n = 13,21%], group II between 100 and 600 ml [n = 39,62%], and group III over 600 ml per 24 hr [n = 11,17%]). Heart disease and lung cancer was found in 6 patients (9%), the remainder suffered from tuberculosis (n = 26,41% on anti tuberculous treatment), pneumonia, COPD and bronchiectasis. Management consisted of bedrest, antibiotics and codeine in all patients. Overall mortality was 6% (4163 patients), the highest mortality found in group III 27% (3/11 patients). Three deaths occurred in patients inoperable due to extensive tuberculosis. Table:
number male : female duration of hemoptysis* previous tb active tb
Hemoptysis <600 ml (I + II)
Hemoptysis >600 ml (III)
52 1.6: 1
11 10: 1
5.6 days
1.6 days
n = 24 (46%)
n = 8 (73%)
n = 11 (21%)
n = 6 (55%)
(tb = tuberculosis), (* = prior to admission) The study suggests: 1) hemoptysis
in a Third World city hospital is mainly due to infectious disease, 2) carries a low mortality, 3) massive hemoptysis occurs mainly in male patients with tuberculosis and a short history of hemoptysis, 4) mortality in this group occurs in inoperable patients. In the majority of patients with hemoptysis in a 3rd World hospital conservative treatment is justified.
506 MAKING USE OF ND - YAG LASER SHARPLAN 2100 WHEN TREATING THE PNEUMOONCOLOGICALLY ILL - A YEAR’S EXPERIENCE AND RESULTS Barton, P., OLO TRN - Medical Institution for Respiratory Diseases, 56943 Jevicko, CZ
TBC
and
Nd-YAG laser SHARPLAN 2001 was introduced in OLfi TRN JeviEko on August 11, 1992. It was intended to be used for the patients from three former regions South Moravia, North Moravia and East Bohemia. 88 patients had been treated by December 31, 1993. Alltogether the laser was used 231 times i.e. on average 2,6 times per patient. The time the performances took was between lo-70 minutes, energy output lo-90 W per performance, number of applied impulses 9-359 in continual order. Used energy in joules was between 70-22.406 J per one treatment. The performances were not followed by any serious complications. 75 patients suffered from bronchial carcinoma, 12 from different tumour, 1 had another diagnosis. The average age of the patients was 60,3 years (20-84). 69 of them were smokers. Total rekanalization of the treated part of the airways was achieved with 50 patients, partial recanalization (or reduction of tumour) with 37 patients. Coagulation was achieved with 6 patients. No effect in 10 cases. When there were multiple loci the effect was evaluated on each of the treated areas.
Tubercle and Lung Disease: Supplement
503 ENDOBRONCHIAL INVASIVE THERAPY APPROACH AND FACILITIES PeSek, M., Bruha, F., Houdek, J.; Pulm. Dpt., Uni Hospital, Tr. E. BeneSe 13, Plzeri, CR
The autors present their 7 year experience with endobronchial miniinvasive therapy (EMIT). They have used 2 cryotherapeutic systems (liquid and N20), 2 lasers (with wavelengths of 1060 and 1320 nm), Laser interstitial hyperthermia, monopolar and bipolar electrodiathermia, high-dose afterloading and combinations of all of these to treat endobronchial obstructions. 95 patients were treated by 165 cryotherapy sessions, 50 laser coagulation sessions, 3 laser resections and 7 laserthermias. The desired effect wps not seen in 5 patients after cryotherapy, in 5 patients after laser therapy and in 1 after electrodiathermia. There were 6 minor complications 1 atelectasis, 1 small pneumothorax, 2 short-term bleeding, 2 short-term hypoxemia during the operation. All of the affected patients fully recovered. In an emergency, laser is the first choice. Howewer, in non emergent situations, softer modalities (cryodestruction, laserthermia) could be used as well. All methods mentioned alone could be used as complementary tools. Various complications of EMIT methods are sometimes more effective then any one of them. 504 LUNG CANCER IN YOUNG
ADULTS
Schoenfeld, N., Bender, J., Kaiser, D., Loddenkemper, R.; Chest Hospital Heckeshorn, Zum Heckeshorn 33, 14109 Berlin, Germany
Conflicting reports have been published on the incidence, prognosis, distribution of histologic type and stage of lung cancer in patients under age 40. We have therefore reviewed the data of 2628 lung cancer patients with definite histo- or cytopathologic diagnosis registered from 1986 in the Cancer Registry of the Chest Hospital Heckeshorn. 54 patients (2.1%) were younger than 40 years. Compared with older patients a higher proportion of patients under age 40 were female (48 vs. 27%). The distribution of cell type was significantly different from older patients (p< 0,001) with a higher proportion of adenocarcinoma (24154; 44 vs. 25 %) and carcinoid tumors (6/54; 11 vs. 1%) and a lower proportion of squamous cell (7/54; 13 vs.31%) and small cell carcinoma (6/54; 11 vs. 23 %). The distribution of tumor stages was also different (p = 0,02) with a higher proportion of stage I (17 vs. 11%) and stage IIIB (30 vs. 14%) in younger patients. KaplanMeier analysis revealed that survival of the younger or older group did not differ significantly for either all histologic types together (mean 569 vs.537 days) or nonsmall-cell cancer (494 vs. 542 days; n=41 and 1954, respectively). We conclude that even though patients under age 40 showed a significantly different distribution of histologic type and tumor stage, their prognosis was similar to the older patients in our series. 505 MANAGEMENT OF HEMOFTYSIS IN A THIRD WORLD CITY HOSPITAL: A RETROSPECTIVE STUDY, KATHMANDU, NEPAL van Kralingen, K. W., Zimmerman, M., Postmus, P. E.; Dept. Pulmonology, Free University Hospital, P. 0. BOX 7057, 1007 MB, Amsterdam, Holland
Massive hemoptysis as defined by blood loss greater than 6OOm1/24hr can carry a mortality of up to 85 % (Garzon et
al. Ann Surg 1972; 187: 267). We undertook a retrospective patient chart study to analyse underlying pathology, management and outcome of hemoptysis patients in a hospital with no thoracic surgical or embolisation facilities. The study group consisted of 63 patients (group I: 100 ml or less [n = 13,21%], group II between 100 and 600 ml [n = 39,62%], and group III over 600 ml per 24 hr [n = 11,17%]). Heart disease and lung cancer was found in 6 patients (9%), the remainder suffered from tuberculosis (n = 26,41% on anti tuberculous treatment), pneumonia, COPD and bronchiectasis. Management consisted of bedrest, antibiotics and codeine in all patients. Overall mortality was 6% (4163 patients), the highest mortality found in group III 27% (3/11 patients). Three deaths occurred in patients inoperable due to extensive tuberculosis. Table:
number male : female duration of hemoptysis* previous tb active tb
Hemoptysis <600 ml (I + II)
Hemoptysis >600 ml (III)
52 1.6: 1
11 10: 1
5.6 days
1.6 days
n = 24 (46%)
n = 8 (73%)
n = 11 (21%)
n = 6 (55%)
(tb = tuberculosis), (* = prior to admission) The study suggests: 1) hemoptysis
in a Third World city hospital is mainly due to infectious disease, 2) carries a low mortality, 3) massive hemoptysis occurs mainly in male patients with tuberculosis and a short history of hemoptysis, 4) mortality in this group occurs in inoperable patients. In the majority of patients with hemoptysis in a 3rd World hospital conservative treatment is justified.
506 MAKING USE OF ND - YAG LASER SHARPLAN 2100 WHEN TREATING THE PNEUMOONCOLOGICALLY ILL - A YEAR’S EXPERIENCE AND RESULTS Barton, P., OLO TRN - Medical Institution for Respiratory Diseases, 56943 Jevicko, CZ
TBC
and
Nd-YAG laser SHARPLAN 2001 was introduced in OLfi TRN JeviEko on August 11, 1992. It was intended to be used for the patients from three former regions South Moravia, North Moravia and East Bohemia. 88 patients had been treated by December 31, 1993. Alltogether the laser was used 231 times i.e. on average 2,6 times per patient. The time the performances took was between lo-70 minutes, energy output lo-90 W per performance, number of applied impulses 9-359 in continual order. Used energy in joules was between 70-22.406 J per one treatment. The performances were not followed by any serious complications. 75 patients suffered from bronchial carcinoma, 12 from different tumour, 1 had another diagnosis. The average age of the patients was 60,3 years (20-84). 69 of them were smokers. Total rekanalization of the treated part of the airways was achieved with 50 patients, partial recanalization (or reduction of tumour) with 37 patients. Coagulation was achieved with 6 patients. No effect in 10 cases. When there were multiple loci the effect was evaluated on each of the treated areas.