The choice of operation for bronchial carcinoids

In a review of the literature, 1,392 patients with bronchial carcinoids were found. Of these, there were 313 patients for whom individual data with regard to type of operation, follow-up period, and outcome were given. Actuarial curves for proportions of patients who had not died of the disease or who had not undergone reoperation for residual disease were constructed for each type of operation. The prognosis up to 20 years after surgical treatment for bronchial carcinoids is excellent. For 15 to 20 years postoperatively, the prognosis after a lobectomy is excellent and after a pneumonectomy, slightly worse. The prognosis after a lung parenchyma-saving operation (wedge or segmental resection and bronchoplastic procedures) is similar to that after a lobectomy up to 7 years postoperatively. After that, the proportion of disease-free patients declines precipitously. At 20 years the difference in comparison with a lobectomy is statistically significant for both wedge or segmental resections and bronchoplastic procedures. Parenchyma-saving operations cannot therefore be said to be radical. A policy for decision-making at the operating table is formulated.     

直肠类癌的诊治现状

直肠类癌属潜在恶性肿瘤,长期以来,一直认为直肠类癌罕见,近年来发现其发病率有增高趋势,临床并不少见,可能与结肠镜技术的进步与人们认识水平的提高有关.由于直肠类癌具有恶变倾向,临床表现无特异性,因此必须重视对它的早期诊断、治疗与随访.直肠类癌的诊断有较高的误诊率,良恶性的判断有时较难把握.目前外科手术是唯一有效的治疗方法,对于手术方式的选择,国内外尚无统一标准,因此总结直肠类癌的诊断及治疗近况具有重要的意义.     

Atypical bronchial carcinoids. Review of 46 patients

BACKGROUND: The purpose of this study was to assess the behaviour of atypical carcinoids operated at our Department in the period 1977-1998 and to review the last 19 cases according to Capella's classification (1994), indicating the most adequate surgical approach. METHODS: On the basis of anatomo-pathological characteristics, we have reviewed surgical treatment and outcome in 46 patients, submitted in the last 22 years to surgical resection for neuroendocrine neoplasms. RESULTS: 5-year survival is 77.2%; 10-year survival is 53.2%. Lymph node metastases are also important for survival, but less than the histotype. The review of our last six years' series, according to Capella's classification, of 19 patients affected by so-called atypical carcinoids revealed that: 5 were well differentiated neuroendocrine tumors (WDNT), 12 were well differentiated neuroendocrine carcinomas (WDNC), 2 were small cell neuroendocrine carcinomas (SCLC). The 5-year overall survival of our cases is 78%, for the WDNT 100%, for WDNC 81.2%. Of the 2 patients with SCLC, one survived 2 months; the other is still alive 5 months after surgery. CONCLUSIONS: The authors conclude that 5-year and 10-year survival are strongly related to the histological type of neuroendocrine neoplasm and to the presence of lymph node metastases. Capella's anatomo-pathological classification helps to give a more accurate prognosis for survival in so-called "atypical carcinoids". If the neoplasm is malignant, the authors recommend radical resection, if possible.     

The diagnosis and treatment of postvagotomy disorders]

From experience with various types of vagotomy in 3,102 patients and study of the late-term results, it was established that recurrent ulcer developed in 4.7%, dysphagia in 2.9%, incompetence of the esophagogastric junction in 9.7%, reflux esophagitis in 3.8%, dyskinesia of the duodenum in 2.6%, duodenostasis in 5.3%, the dumping syndrome in 5.4%, diarrhea in 6.1%, and hiatal hernia in 0.3% of cases. The surgical correction of disorders after vagotomy is marked by specific techniques which must be borne in mind to improve treatment.     

The diagnosis and treatment of kidney ruptures]

An experience with diagnostics and treatment of 21 patients with injuries of the kidney is presented. Possible ways to determine the kind and localization of the rupture of the kidney with the help of computed tomography are described.     

Surgery in bronchial carcinoids: experience with 83 patients.

OBJECTIVE: With the changing clinical presentation and histopathological pattern, carcinoids are now considered as a distinct and well-defined group in the neuroendocrine tumour scale. Surgery, especially parenchyma-sparing operations, are the treatment of choice for carcinoids. METHODS: Over a 25-year period, 83 patients with typical carcinoid tumour underwent thoracotomy on in our institution. The records of the patients were reviewed and the results were evaluated. RESULTS: The diagnosis was made with radiological methods and bronchoscopy. Cough and recurrent pneumonia were the most common symptoms. A variety of surgical procedures were performed. Thirty of the 83 patients underwent tissue-saving operations. Twenty patients underwent bronchotomy excision, eight were managed with sleeve or partial sleeve resective procedures, and two underwent segmentectomy. CONCLUSIONS: Conservative surgery is the treatment of choice of carcinoids, which were histologically typical and anatomically endobronchial. Especially for polypoid type carcinoids and for selected cases with sessile type, bronchotomy with simple excision and sleeve resections is a simple and effective method. As these types of operations produce a better functional result, they should be encouraged in these patients.     

The diagnosis and treatment of pulmonary artery thromboembolisms]

The article discusses experience in the diagnosis and methods of treatment of thromboembolism of the pulmonary arteries at the Department of Surgery of the Vessels of the Scientific Research Institute of Experimental Surgery. There were 238 patients under observation. A complex of modern diagnostic methods were applied, including, besides the routine methods of examination, angiopulmonography with measurement of blood pressure in the pulmonary trunk and right heart chamber and scanning of the lungs. Thus, comparison of the modern antipulmonological and isotope examinations allow a correct intravital diagnosis of thromboembolism of the pulmonary artery to be established. Administration of thrombolytics into the focus of affection by catheterization of the pulmonary artery is the most effective method of nonoperative treatment.     

Tracheobronchography in the diagnosis of bronchial fistulas following pulmonectomy]

The authors present an analysis of contrast investigations of the trachea and the main bronchus stump in patients subjected to pneumonectomy (35 patients), the first group--with the presence of bronchial fistula and pleural empyema, the second group--with a suspicion to fistula in the stump. Tracheobronchography proved to be considerably more informative with respect to the diagnosis of bronchial fistula, than tracheobronchoscopy in patients of both groups. Contrast studies of the stump gave objective evidences as to the length and form of the stump, its communication with the pleural cavity, in 1/4 of patients it enabled the investigators to reveal the presence of cavaties adjacent to the stump in the mediastinum and to pinpoint further in indications to surgery. A more wide application of tracheobronchography for diagnosis of bronchial fistulas after pneumonectomy in largely advocated.     

The diagnosis and treatment of diseases of dystopic kidneys]

The analysis is presented of 64 surgical cases of affected dystopic kidneys. Of these, 34 had urolithiasis, 6 renal tumors, 10 hydronephrosis, 14 chronic pyelonephritis. The principal diagnostic facility was radionuclide renal scintigraphy. On deciding on the operative treatment, additional use of angiography, cystography and other methods is advisable. Diagnostic findings and treatment variants are described.     

Clinical considerations on malignant carcinoids: bronchial, gastric, ileocolic involvement

Six cases of malignant neuroendocrine tumours (3 bronchial, 1 ileocolic) are presented; diagnostic and clinical features, functional behaviour and the results of the treatment are discussed. Early functional manifestation (diarrhoea) was observed only in the first case of ileocolic tumour: in this patient the diarrhoea disappeared after the operation but further relapse occurred at the recurrence of the pathology. In the second ileocolic tumour diarrhoea with increased levels of 5 HT appeared later on, after the operation, expressing repeated disease. In one malignant bronchial carcinoid with early spinal secondary, the typical flushes appeared only after the explosion of metastatic spread. No functional disorders were observed in one patient with metastasis localised only in the bones. On the basis of actual knowledge the authors discuss the pathogenetic hypothesis of these events. Even though these experience limited, it may remark the importance of the quantity and quality of produced hormones, of the localization of metastasis in the liver and portal district and the unconstant production of clinical symptoms. The importance of A-chromogranin and of NSE as specific markers is discussed; the studies on the chromogranin have furthermore demonstrated the possible effect of the inhibitors of protonic pump on structural, hyper-dysplastic modification of gastric mucosa and this requires further investigation.     

The diagnosis and treatment of complex forms of inguinal hernias]

The volume pressure of the hydrodynamic stroke, and the "preservation" of the anterior and posterior walls of the inguinal canal were studied before and during operation in 100 patients with complex forms of inguinal hernia by means of devices suggested by the authors. With consideration for the obtained objective data, four degrees of severity of the disease were distinguished and the optimal methods for surgical correction were indicated.     

The diagnosis and treatment of hepatopulmonary fistulae of amebic etiology]

The author has analyzed results of treatment of 28 patients with hepato-thoracic complications of amebic abscesses of the liver. Different variations of operative interventions are proposed including the separate (subdiaphragmatic) draining of the cavity of the liver abscess and pleural cavity and in cases of the appearance of bilio-bronchial fistulas--resection of the lung.