- Email: [email protected]
Thymomas in Myasthenia gravis (MG)
Surgery invasive C; 2) input level of blood cell subpopulations circuit; 3) ratio of C cell population quantity to blood cell subpopulations quantity in integral LCP organim (cell ratio factors: CRF); 4) C characteristics (C cell population quantity, TNMG-system); 5) the data of blood biochemic homeostasis. Rates of age, sex, C cell type for survivors and lost LCP were not significantly different. Structural equation modeling and Monte Carlo simulation confirmed significant overall networks between 5YS (LS) of LCP and blood cell subpopulations circuit (X2 = 10485.5; k = 169; T = 4.747; P = 0.02e-4), biochemical homeostasis (X2 = 239.6; K = 64; T = -3.64; P = 0.0003), phase transition of early C into invasive C (X2 = 5.540; k = 1; T = 3.711; P = 0.0002), CRF (X2 = 4017.8; k = 43; T = 4.377; P = 0.00001), C characteristics (X2 = 98.6; k = 13; T = -4.635; P = 0.03e-4).
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Surgico-therapy for lung cancer at the National Institute for Tuberculosis And Respiratory Diseases, Hanoi, Vietnam
T.T.K. Dung, N.V. Co, I~T.P. Anh. Department of Thoracic Surgery,
NITRD, Vietnam During two years 1997-1998 at the Department of Thoracic Surgery, National Institute for Tuberculosis and Respiratory Diseases (NITRD), 500 in-patients were operated. (40% out of in-patients suffered from lung cancer) There were 454 males (90.8%) and 56 females (9.2%). The oldest was 80 years of age and the youngest was 13 years of age. Patients suffered from lung cancer at the age over 40 account for 89%. The average age of all patients is 56.3 among males and 52.4 among females. Smokers reached the proportion at 80% and 30 year smoking patients are 41%. Post-operation classification shows that: Carcinomaepidermoide (with the highest proportion): 41%; Adeno-carcinoma: 25.8%; Large cell: 15.4%; Small cell: 11.4% and Adeno-squamous: 5.2%. Males suffered mainly from Carcinoma-epidermoide 43% and females from Adenocarcinoma 50%. Surgical operation now is carried out at late phase. The classification of TNM finds that: Stage IliA: 68.8%; stage I1: 15.2%; stage I: only 5.4% and stage IIIB: 10.6%. Lobectomy was the main measure: 73.6%; Pneumonectomy: 19.6%; Exploratory: 6.8% There is a raising tendency of surgico-therapy for lung cancer in Vietnam. The majority of patients are admitted at late phase. The operation aims mainly at Iobectomy and removed lymph node.
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Diagnosis & treatment of 12 cases of pneumonic carcinoma characterized by pericardial effusion as first symptom
Z. Kai. Dept. of Heart & Chest Surgery, Central Hospital of DMF,
Shiyan, HubeL China Objective: To apprehend the special rule of pneumonic carcinoma characterized by pericardial effusion as first symptom. Methods: To treat such a kind of pneumonic carcionma with polymethods therapy. Results: In the groups of patients all of which contracted undifferentiated carcinoma, the survival time was longer while treated by poly-methods than by single method. Conclusion: Polymethods therapy should be used to the pneumonic carcinoma characterized by as pericardial effusion first symptom
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Solitary fibrous tumor of the pleura: A report of 3 cases with immunohistochemical study
Kita 1,2, H. Nogimura 2, Y. Kageyama 1, S. Ohi 1, K. Suzuki 1, T. Kazui 1. 1First Dept. of Surgery, Hamamatsu University School of
Medicine, Hamamatsu; 2Dept. of Thoracic Surgery, Haibara General Hospital Shizuoka, Japan Three patients had a solitary fibrous tumor (SFT) of the pleura, arising from the lung parenchyma. The lesions occurred in one female and two males. The age of patients ranged from 46 to 58 years old. The
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tumors presented as cough with blood blood-tinged sputum, or as asymptomatic masses detected by routine chest radiograph. All the tumors were well circumscribed, attached to the visceral pleura by pedicule and surgical resection confirmed the diagnosis. Microscopically, the benign tumors showed the fibrous areas consisted of low to moderate cellularity with loosely arranged spindle-shaped or oval cells. The malignant tumors were composed of cytologically atypical cells enmeshed in a collagenous and myxoid extracellular matrix. Mitosis and nuclear pleomorphism were present. Immunohistochemically, the tumor cells were immunoreactive for vimentin and, especially, CD34, but not for cytokeratin, carcinoembryonic antigen and EMA. These observations support the nonmesotherial origin of the cells of these tumors. Follow-up data, ranging from 6 to 74 months, were obtained in all cases. No recurrences or metastasis were detected after local excision. The differentiation of SFT from mesothelioma can be achieved by immunophenotyping including CD34.
[ 4Thymomas 8 - in 0Myasthenia 7 gravis (MG) G. Menga, M Rosenberg, G. Olmedo, C. Poleri, L. Rey, O. Rojas, O. Abdala. Hospital "Maria Ferrer", Buenos Aires, Argentina Thymomas are primary epithelial neoplasms of de thymus frequently associated with autoimmunes diseases, particularly myasthenia gravis (MG). Hospital Maria Ferrer is a referral Center for thoracic surgery and MG. From 1968 to 1989, 1250 myastenic patients were admitted to the Hospital. During this period 350 thymectomies were performed on these patients. Seventy-nine had thymomas. Sixteen (16) patients were lost to follow-up. In the remaining 63 patients we tried to correlate the curse of MG with histopathological findings. Thymomas were classified according to Bernatz (1968) and Kirchner and M~ller-Hermelink (1989) The male to female ratio was 1:1; mean age at diagnosis was 45 ~E 15 years. By far, the type most frequently seen was the epitelial type (43%, Bernatz) and the cortical type 73% (Kirchner - M. Hermellink). They were predominantly in stage I (55%) and stage II (27%). Only 10 (13%) were in stage III and 4 (5%) in stage IV (Masaoka). Only seven patients received chemotherapy (9%) before being operated due to invasiveness of the tumor. Postoperative radiotherapy was performed in 22 (28%) patients, all of them with invasive thymomas. Seventeen patients died: 7 in the postoperative period, 8 due to MG and 2 because of progression of thymoma. In only 6 patients there was a complete remission of myastenic symptons, remarkably all of them had thymomas of the lymphoepithelial type instead of the more frequent ephithelial type. Conclusions: Our results agree with other published series in that thymomas in MG were mostly epithelial and cortical and in stage II or I at the time of surgery. Patients had a good clinical response regardless the type or grade of invasion of thymoma, however, the response to thymectomy on MG was poor: only 6 had complete remission of the symptoms and most of them remained stable under specific therapy for MG.
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Non-rib-spreading formal thoracotomy for lung cancers
S.S. Chung, C.K. Lo, K.K. Ho, C.C. Ma. Dept. of Cardiothoracic
Surgery, Queen Elizabeth Hospital Hong Kong, China Conventional posterolateral thoracotomy is the time-honored approach for lung cancer surgery despite significant wound pain. The hypothesis that the persistent pain is due to rib spreading with ligament injury is widely believed. However, avoiding rib spreading may compromise exposure and surgical safety. This study is aimed at studying the feasibility of lung cancer surgery by non-rib spreading thoracotomy for selected patients. The established alternative of video assisted thoracoscopic surgery is compelling except for its higher cost and skill. Three patients aged 50, 63 and 66 were selected on the basis of the tumour size (<4 cm). Curvilinear posterolateral incision was made as usual thoracotomy. Lattisimus dorsi and serratius anterior were divided. The sixth rib was cut at both ends of the incision. The
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Surgico-therapy for lung cancer at the National Institute for Tuberculosis And Respiratory Diseases, Hanoi, Vietnam
T.T.K. Dung, N.V. Co, I~T.P. Anh. Department of Thoracic Surgery,
NITRD, Vietnam During two years 1997-1998 at the Department of Thoracic Surgery, National Institute for Tuberculosis and Respiratory Diseases (NITRD), 500 in-patients were operated. (40% out of in-patients suffered from lung cancer) There were 454 males (90.8%) and 56 females (9.2%). The oldest was 80 years of age and the youngest was 13 years of age. Patients suffered from lung cancer at the age over 40 account for 89%. The average age of all patients is 56.3 among males and 52.4 among females. Smokers reached the proportion at 80% and 30 year smoking patients are 41%. Post-operation classification shows that: Carcinomaepidermoide (with the highest proportion): 41%; Adeno-carcinoma: 25.8%; Large cell: 15.4%; Small cell: 11.4% and Adeno-squamous: 5.2%. Males suffered mainly from Carcinoma-epidermoide 43% and females from Adenocarcinoma 50%. Surgical operation now is carried out at late phase. The classification of TNM finds that: Stage IliA: 68.8%; stage I1: 15.2%; stage I: only 5.4% and stage IIIB: 10.6%. Lobectomy was the main measure: 73.6%; Pneumonectomy: 19.6%; Exploratory: 6.8% There is a raising tendency of surgico-therapy for lung cancer in Vietnam. The majority of patients are admitted at late phase. The operation aims mainly at Iobectomy and removed lymph node.
•7-8•
Diagnosis & treatment of 12 cases of pneumonic carcinoma characterized by pericardial effusion as first symptom
Z. Kai. Dept. of Heart & Chest Surgery, Central Hospital of DMF,
Shiyan, HubeL China Objective: To apprehend the special rule of pneumonic carcinoma characterized by pericardial effusion as first symptom. Methods: To treat such a kind of pneumonic carcionma with polymethods therapy. Results: In the groups of patients all of which contracted undifferentiated carcinoma, the survival time was longer while treated by poly-methods than by single method. Conclusion: Polymethods therapy should be used to the pneumonic carcinoma characterized by as pericardial effusion first symptom
•7-•
Solitary fibrous tumor of the pleura: A report of 3 cases with immunohistochemical study
Kita 1,2, H. Nogimura 2, Y. Kageyama 1, S. Ohi 1, K. Suzuki 1, T. Kazui 1. 1First Dept. of Surgery, Hamamatsu University School of
Medicine, Hamamatsu; 2Dept. of Thoracic Surgery, Haibara General Hospital Shizuoka, Japan Three patients had a solitary fibrous tumor (SFT) of the pleura, arising from the lung parenchyma. The lesions occurred in one female and two males. The age of patients ranged from 46 to 58 years old. The
143
tumors presented as cough with blood blood-tinged sputum, or as asymptomatic masses detected by routine chest radiograph. All the tumors were well circumscribed, attached to the visceral pleura by pedicule and surgical resection confirmed the diagnosis. Microscopically, the benign tumors showed the fibrous areas consisted of low to moderate cellularity with loosely arranged spindle-shaped or oval cells. The malignant tumors were composed of cytologically atypical cells enmeshed in a collagenous and myxoid extracellular matrix. Mitosis and nuclear pleomorphism were present. Immunohistochemically, the tumor cells were immunoreactive for vimentin and, especially, CD34, but not for cytokeratin, carcinoembryonic antigen and EMA. These observations support the nonmesotherial origin of the cells of these tumors. Follow-up data, ranging from 6 to 74 months, were obtained in all cases. No recurrences or metastasis were detected after local excision. The differentiation of SFT from mesothelioma can be achieved by immunophenotyping including CD34.
[ 4Thymomas 8 - in 0Myasthenia 7 gravis (MG) G. Menga, M Rosenberg, G. Olmedo, C. Poleri, L. Rey, O. Rojas, O. Abdala. Hospital "Maria Ferrer", Buenos Aires, Argentina Thymomas are primary epithelial neoplasms of de thymus frequently associated with autoimmunes diseases, particularly myasthenia gravis (MG). Hospital Maria Ferrer is a referral Center for thoracic surgery and MG. From 1968 to 1989, 1250 myastenic patients were admitted to the Hospital. During this period 350 thymectomies were performed on these patients. Seventy-nine had thymomas. Sixteen (16) patients were lost to follow-up. In the remaining 63 patients we tried to correlate the curse of MG with histopathological findings. Thymomas were classified according to Bernatz (1968) and Kirchner and M~ller-Hermelink (1989) The male to female ratio was 1:1; mean age at diagnosis was 45 ~E 15 years. By far, the type most frequently seen was the epitelial type (43%, Bernatz) and the cortical type 73% (Kirchner - M. Hermellink). They were predominantly in stage I (55%) and stage II (27%). Only 10 (13%) were in stage III and 4 (5%) in stage IV (Masaoka). Only seven patients received chemotherapy (9%) before being operated due to invasiveness of the tumor. Postoperative radiotherapy was performed in 22 (28%) patients, all of them with invasive thymomas. Seventeen patients died: 7 in the postoperative period, 8 due to MG and 2 because of progression of thymoma. In only 6 patients there was a complete remission of myastenic symptons, remarkably all of them had thymomas of the lymphoepithelial type instead of the more frequent ephithelial type. Conclusions: Our results agree with other published series in that thymomas in MG were mostly epithelial and cortical and in stage II or I at the time of surgery. Patients had a good clinical response regardless the type or grade of invasion of thymoma, however, the response to thymectomy on MG was poor: only 6 had complete remission of the symptoms and most of them remained stable under specific therapy for MG.
[
•
Non-rib-spreading formal thoracotomy for lung cancers
S.S. Chung, C.K. Lo, K.K. Ho, C.C. Ma. Dept. of Cardiothoracic
Surgery, Queen Elizabeth Hospital Hong Kong, China Conventional posterolateral thoracotomy is the time-honored approach for lung cancer surgery despite significant wound pain. The hypothesis that the persistent pain is due to rib spreading with ligament injury is widely believed. However, avoiding rib spreading may compromise exposure and surgical safety. This study is aimed at studying the feasibility of lung cancer surgery by non-rib spreading thoracotomy for selected patients. The established alternative of video assisted thoracoscopic surgery is compelling except for its higher cost and skill. Three patients aged 50, 63 and 66 were selected on the basis of the tumour size (<4 cm). Curvilinear posterolateral incision was made as usual thoracotomy. Lattisimus dorsi and serratius anterior were divided. The sixth rib was cut at both ends of the incision. The