Invasion of blood vessels as significant prognostic factor in radically resected T1-3N0M0 non-small-cell lung cancer.

OBJECTIVES: Radical resection is the therapy of choice in non-small-cell lung cancer (NSCLC). However, even in early stages (T1N0, T2N0) up to 35% of patients will experience recurrence. The aim of this retrospective study was to evaluate the prognostic influence of lymph vessel or blood vessel invasion in N0 patients. METHODS: A total of 72 patients (male, 49; female, 23; median age 59; range 40-72) with NSCLC entered the study. The stages were T1-3N0 (T1, 25; T2, 41; T3, 6). Thirteen pneumonectomies and 59 lobectomies or bilobectomies with systematic lymphadenectomy and R0 resection were performed. Histologically, 24 adenocarcinomas, 31 squamous cell carcinomas and 14 subtypes of large cell carcinoma were found. In 22 cases microscopic invasion of the lymphatic vessels and in 11 invasions of blood vessels were found. Six patients showed invasion of either structure. RESULTS: The patients were followed up for at least 5 years or until death. During the follow-up period 27 patients died (21 because of recurrence and 6 because of diagnosis not related to NSCLC). The 5 years overall survival amounted to 62.5%. In cases with invasion of the blood vessels the survival rate was 23.5%, in cases without invasion 74.5% (P< or = 0.01), whereas lymph vessel invasion had no significant impact on survival. Multivariate analysis covering T stages, histological subtypes, location of the tumor, grading, age, sex, and invasion of the lymphatic or the blood vessels showed invasion of the blood vessels as the only factor with significant prognostic impact in the study population. CONCLUSIONS: In resectable N0 patients with NSCLC the microscopic invasion of blood vessels should be considered as an additional prognostic parameter.     

Effect of postpartum maternal infection on proteins and trace elements in colostrum and early milk

In developing countries, maternal infections during lactation are common. In this study, we evaluated the effect of acute maternal postpartum infection on the composition of colostrum and early milk with special emphasis on milk proteins and trace elements. The study was carried out in two maternity hospitals in Lima, Peru. Subjects were normally nourished women (body mass index (BMI) > 20.0) who intended to exclusively breastfeed their child and who had fever and clinical symptoms of infection within the first 48 h postpartum ( n = 34). Non-ill women of similar characteristics were selected as controls ( n = 23). Blood and milk samples were taken on days 1 and 14 postpartum. An acute phase response was confirmed by significantly increased serum levels of C-reactive protein in infected women. Serum zinc levels increased significantly from day 1 to day 14, but were not affected by infection. Serum copper levels were significantly higher in ill women than in non-ill women on day 1. All participating women were breastfeeding on day 14. Whey protein levels, the whey/casein ratio and total protein levels decreased significantly with time, but were not affected by infection. There were no differences in milk iron or copper levels with time or infection. Milk zinc levels decreased significantly with time, but were not affected by infection. Maternal infection during the early postpartum period does not appear to adversely affect the initiation of lactation or milk protein and trace element contents.     

Thyroiditis from the surgical viewpoint

1296 Patients were treated for thyroid disorders in the Surgical Clinic of the University of Graz between 1975 and 1981. In 3.5% thyroiditis was diagnosed, 75% struma lymphomatosa Hashimoto and 25% subacute thyroiditis de Quervain. 75% of all cases were classified only by histological postoperative examination. Suspected malignancy leads in most cases to operative treatment, but there are also indications because of the inflammatory lesion. We do not believe that thyroiditis should be treated surgically as thyroid carcinoma, neither provides the low incidence between carcinoma and thyroid inflammation any radicality for preventing malignant disorders.