Studies of resected small lung cancer associated with intrapulmonary metastasis

We studied on intrapulmonary metastasis in 6 out of 136 cases where the resection for lung cancer was performed at Fukui Red Cross Hospital from 1984 to 1990. Four out of 6 were small lung cancer cases. The histological types were as follows: 4 adenocarcinomas and 2 squamous cell carcinomas. In adenocarcinoma cases, intrapulmonary metastasis tended to scatter to other pulmonary lobe and to increase in number. On the other hand, in squamous cell carcinoma cases, intrapulmonary metastasis was solitary and localized in the same pulmonary lobe as that of the primary lesion. Two squamous cell carcinoma cases were alive, and one of these was alive for more than 4 years in small lung cancer cases. It is suggested that in cases of intrapulmonary metastasis localized in the same pulmonary lobe as that of the primary lesion, to be expected metastatic route to be included in resected lobe, surgical operation is recommended, especially in squamous cell carcinoma cases.     

Extralobar lung sequestration associated with fatal neonatal respiratory distress

The radiological and pathological findings of lung sequestration in a premature infant are described. There was a left-sided variant of the extralobar type with double systemic arterial blood supply, single systemic venous drainage, and an incomplete bronchial tree for the remainder of the left lung.     

呼吸功能训练对肺癌患者术后肺功能的影响

目的通过探讨呼吸功能训练对肺癌患者术后肺功能的影响。方法将80例肺癌术后患者分为观察组、对照组,每组40例。对照组采用传统的常规护理,观察组在对照组的基础上,采取在围手术期对患者呼吸功能训练的护理干预,入院后第一天及术后第一周对肺功能的测定。结果术前两组血气指标、肺功能指标等无明显差异(P0.05);术后一周观察组血氧饱和度、氧分压、FEV1%、FEV1\FVC%指标值均优于对照组,差异具有统计学意义(P0.05)。观察组肺功能质量均好于对照组,并且患者对术后的生活质量期望值明显提高。结论肺癌术后在常规护理基础上进行呼吸功能训练可提高肺癌患者术后的呼吸功能,促进肺功能的恢复。     

术前肺功能参数预测低肺功能患者肺癌根治术后并发呼吸衰竭的评价

目的对拟行肺癌根治术的低肺功能患者进行常规肺功能检测和脉冲强迫振荡技术（IOS）检测，评价术前肺功能参数预测低肺功能患者肺癌根治术后并发呼吸衰竭的价值。方法按照常规肺功能评价标准和术前肺功能测定结果，选择52例拟行肺癌根治术、低肺功能患者，根据术后是否发生呼吸衰竭分为呼衰组和非呼衰组。术前检测常规肺功能参数：第1秒用力呼气容积（FEV1．0）、肺活量（VC）及最大通气量（MVV）；IOS检测参数：周边气道阻力（R5-R20）、弹性阻力（X5）、共振频律（Fres）。结果两组FEV1．0、R5-R50、X5、Fres差异有统计学意义（P〈0．05）；Logisfic回归分析显示仅Fres为预测术后呼吸衰竭发生的独立因素（P〈0．01）。结论Fres有助于预测低肺功能肺癌患者全肺切除术后是否发生呼吸衰竭。     

Effects of lung metastasectomy on respiratory function

OBJECTIVE: The effects of lung metastasectomy on respiration were evaluated. SUBJECTS: From 1961 to 1999, 203 patients underwent lung metastasectomy. Of these, 102 patients who had undergone only partial lung resection, had undergone sufficient respiratory function testing, and had not suffered from other lung disease were included. RESULTS: Unilateral thoracoscopic surgery caused less decrease in percent vital capacity than surgery through a posterolateral thoracotomy, in both the early (rate of decrease: 16.2 +/- 9.1 vs. 33.0 +/- 12.0%, p < 0.01), and the late postoperative period (2.0 +/- 4.5 vs. 17.8 +/- 6.0%, p < 0.0001). Two thoracoscopic operations caused less decrease in percent vital capacity than 2 operations through a posterolateral thoracotomy (21.3 +/- 13.8 vs. 61.1 +/- 8.1%, p = 0.02). Bilateral metastasectomy through a median sternotomy caused less decrease in percent vital capacity than that through posterolateral thoracotomies (45.5 +/- 13.7 vs. 60.8 +/- 8.8%, p < 0.05). Four (36%) of 11 patients who had undergone 3 or more metastasectomies exhibited dyspnea of degree 3 or higher on the Hugh-Jones classification. CONCLUSIONS: Thoracoscopic metastasectomy and metastasectomy through a median sternotomy caused less restrictive respiratory dysfunction than metastasectomy through a posterolateral thoracotomy. Since metastatic lung disease often necessitates repeated metastasectomy, and repeated metastasectomy often causes severe restrictive respiratory dysfunction, metastasectomy should be performed with a less invasive procedure.     

Changing pattern of respiratory tuberculosis in the UK in adult patients from the Indian subcontinent

BACKGROUND: Clinical observations over a 12 year period have suggested a changing pattern of adult respiratory tuberculosis in patients from the Indian subcontinent in two districts of the United Kingdom with a high incidence of tuberculosis. METHODS: Details of all patients for the period 1981-92 residing in the Newham and Blackburn districts aged 15 and over whose ethnic origin was from the Indian subcontinent (n = 1308) were analysed by stepwise logistic regression to determine the relationship between sputum smear positivity, sputum culture positivity, and isolated mediastinal lymphadenopathy, year of notification, age, sex, ethnic group (Indian or Pakistani), and whether the patient had visited the Indian subcontinent within the last three years. RESULTS: The proportion of cases who were smear positive rose over the 12 years of the study, as did the proportion of culture positive cases. The proportion with isolated mediastinal lymphadenopathy fell. These changes took place in both districts. They were not explained by demographic changes in age, sex, or ethnic group, nor was there evidence that smear and culture positivity increased in those who had recently visited India or Pakistan. CONCLUSIONS: The pattern of tuberculosis in adult patients originating from the Indian subcontinent has altered over time towards that seen in the white population in the UK.




     

左上肺叶肺泡微结石症合并腺癌1例

肺泡微结石症(pulmonary alveolar mierolithiasis)，是一种以肺泡内涵细纱样结石伴(或不伴)有肺实质纤维化为特征的少见疾病，我院胸外科于2003年4月7日曾收治左上肺叶肺泡微石症合并细支气管肺泡癌1例，现报告如下。     

A hepatoblastoma originating in the caudate lobe radically resected with the inferior vena cava.

Complete resection of a rare hepatoblastoma in the caudate lobe, involving the inferior vena cava (IVC), is reported. After systemic chemotherapy, a 5-year-old child underwent exploratory laparotomy at another hospital, but resection was not attempted because the tumor in the caudate lobe had extensively invaded the retrohepatic IVC. However, because not only the lack of distant metastases but also the establishment of extrahepatic collaterals were confirmed by imaging, we thought it was possible to radically resect the tumor. We successfully performed an extended left hepatic lobectomy including total excision of the caudate lobe and the involved portion of the IVC. Although we did not reconstruct the IVC, no clinical manifestations arising from caval congestion were seen. The serum alpha-fetoprotein value declined below the normal limit. Our experience with this case has introduced a radical resectability for hepatic malignancy in the caudate lobe, even if it has extended into the IVC.     

Non-invasive ventilation is associated with long-term improvements in lung function and gas exchange in cystic fibrosis adults with hypercapnic respiratory failure

BackgroundNon-invasive ventilation (NIV) is an established treatment option for cystic fibrosis (CF) patients with type 2 respiratory failure but the benefits of this therapy remain unclear. This study examined the long-term outcomes and response to NIV in a large adult CF cohort.MethodsAll patients attending a UK adult CF Centre receiving NIV as treatment for hypercapnic respiratory failure over a nine-year period were studied prospectively. Detailed clinical data was recorded and longitudinal data measurements were examined for the three years pre and post NIV initiation to assess effect of this intervention.Results94 patients, mean age 29.9 (SD 9.7) years, percent predicted FEV₁ 21.5 (7.3), received NIV. All patients commenced NIV in a hospital setting. 21 remain alive, 24 received double lung transplant, 49 died without lung transplantation. NIV use was associated with a stabilisation and improvement in both FEV₁ and FVC from NIV set up to three years post follow-up, in addition to an increase in body mass index and attenuation of PCO₂ (all p<0.001). No single parameter was found to predict long-term NIV response but baseline PCO₂ (p=0.005), CRP (p=0.004) and age (p=0.009) were identified as independent predictors of mortality.ConclusionsNIV use in CF adults is associated with improvements in lung function and attenuation of hypercapnia which is maintained for up to three years post NIV initiation. Outcomes for CF patients with severe pulmonary disease commenced on NIV have significantly improved with fifty percent of patients expected to survive for approximately five years.     

The significance of associated pre-invasive lesions in patients resected for primary lung neoplasms.

OBJECTIVE: To evaluate the prevalence and clinico/prognostic significance of the presence of pre-invasive lesions in patients resected for primary lung neoplasm. METHODS: From 1993 to 2002, 1090 patients received resection for primary lung carcinomas. Of these, 73 presented an associated pre-invasive lesion in the surgical specimen distant from the primary tumour. Classification of pre-invasive lesions included Atypical Adenomatous Hyperplasia (AAH); Carcinoma In Situ (CIS) either diffuse or at the bronchial resection margin; Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH). Correlation between the presence of pre-invasive lesion and the following variables were calculated by logistic regression analysis: sex, age, median tumour size, histology, histologic differentiation, histologic evidence of invasiveness (vascular and perineural invasion), peritumoural lymphocytic infiltrate, pTNM, lobe location, history of previous malignancy. Survival rates were computed using Kaplan-Meier method and survival differences with the total patient population of resected lung carcinomas were tested using the log-rank method. RESULTS: There were 28 AAH, 42 CIS (5 at the bronchial resection margin) and 3 DIPNECH. Histology of the primary tumor included bronchioloalveolar carcinoma (9 patients), adenocarcinoma (19), squamous cell carcinoma (39), typical carcinoid tumour (3) and adenosquamous carcinoma (3). Overall prevalence of pre-invasive lesion was 6.7%. A strong correlation was found between the presence of AAH and the co-existence of either adenocarcinoma, bronchioloalveolar carcinoma or mixed adenocarcinoma-containing tumours (P = 0.00002) between CIS and squamous cell carcinoma (P = 0.009) and between DIPNECH and carcinoid tumours (P = 0.001). No significant correlation was found between the presence of any type of pre-invasive lesion and sex, age, median tumour size, histologic differentiation, histologic evidence of invasiveness, pTNM, lobe location and history of previous malignancy or the probability to develop a second primary lung carcinoma in the remaining lobe(s) after resection. Survival rates in the patients with AAH and CIS were not significantly different from those of patients without pre-invasive lesion (P = 0.3 and P = 0.1). CONCLUSIONS: Associated pre-invasive lesions in patients resected for primary lung neoplasms are not infrequent. AAH is associated with adenocarcinoma, CIS with squamous cell carcinoma, DIPNECH with typical carcinoid tumours. Our experience indicates that in these patients histology, stage distribution and survival do not differ from the total population of resected patients with lung tumors.     

The pattern of mediastinal nodal involvement in lung cancer according to tumor-located lobe]

To clarify the pathway of the metastases from each pulmonary lobe to mediastinal nodes, we examined the pattern of mediastinal nodal involvement in 462 resected pN2 non-small cell lung cancer. Carcinomas of the right upper lobe frequently involved #3 (78/133) and #4 (70/133) nodes, whereas those of the right middle or lower lobe frequently metastasized to #7 nodes (18/23 and 86/113, respectively). On the other hand, carcinoma of left upper lobe frequently involved #5 nodes (81/118), whereas those of the left lower lobe most frequently metastasized to #7 nodes (50/75). Of 462 pN2 patients, 95 (20.6%) had skip metastases to the mediastinal nodes. Skip metastasis was observed more frequently in carcinomas of right upper and middle lobe. One of the reasons of skip metastasis may be the direct lymph drainage through subpleural space to mediastinum.     

Symptomatic accessory lobe of the liver associated with hyperthyroidism

A case of symptomatic accessory lobe of the liver occurred in a 15-year-old Japanese girl with hyperthyroidism. The patient presented with acute abdominal distress; at operation, a twisted necrotic mass of the accessory lobe of the liver was found. A review of the literature failed to show a previously reported instance in a child.