自体角膜缘上皮移植联合贝复舒治疗翼状胬肉的疗效观察

目的 观察自体角膜缘上皮移植联合贝复舒对角膜缘上皮修复的作用。方法 随机选择翼状胬肉患者98例(98只眼)，治疗组为自体角膜缘上皮移植联合贝复舒，对照组为翼状胬肉切除联合贝复舒。术后每日观察角膜上皮缺损区的修复情况，并随诊观察复发情况。结果 治疗组角膜缘上皮平均修复时间为3．1天，对照组4．2天，有显著差异性。随诊6个月发现对照组有一例复发，均未发现感染。结论 自体角膜缘上皮移植联合贝复舒可使角膜缘上皮修复时间快于翼状胬肉切除联合贝复舒。复发率均较低，表明自体角膜缘上皮移植联合贝复舒治疗翼状胬肉可以加快角膜缘上皮修复，减少复发及感染的机会。     

The role of silicone stents in the treatment of cicatricial tracheal stenoses

OBJECTIVE: Tracheal stenting for cicatricial stenoses is reserved for patients whose lesions are deemed inoperable for local or general reasons. The aim of our study was to verify the long-term results of silicone tracheal stents in such a clinical setting. METHODS: Clinical data of 45 patients treated by tracheal silicone stents, between 1987 and 1999, were reviewed. All patients had highly symptomatic cicatricial stenoses; they were selected for stenting rather than for surgery because of local and general conditions. This series has been divided in two groups according to the purpose of stenting: bridge to surgery or definitive treatment. Follow-up ranged between 12 and 83 months. Twenty-seven patients received a Montgomery T tube (Hood Laboratories, Pembroke, Mass), 16 a Dumon stent (Novatech, Plan de Gras, France), and 2 a Dynamic stent (Rusch, Kernen, Germany). RESULTS: No procedure-related mortality was observed. Nine patients underwent curative resection and reconstruction after a variable stenting period; one had a recurrent stenosis and was treated for palliation with a T tube. Tracheal stenting was performed for palliation as a definitive treatment in 37 patients. Among this group, 11 patients died of unrelated causes at a median of 10 months after the endoscopic treatment. The stent was permanently removed in 10 after a median interval of 32 months (range 9-70 months); in 4 others, symptomatic recurrence of the stenosis was observed within 6 weeks of stent removal. None of the patients successfully decannulated had a completely normal tracheal lumen but all remained asymptomatic because the residual stenosis was mild or well tolerated for concomitant limitation of physical activity. CONCLUSIONS: Long-term treatment with a silicone stent was safe and well tolerated in cicatricial tracheal stenoses. This procedure can be considered as a bridge to curative surgery or as a definitive treatment. The latter, generally performed for palliation, may provide satisfactory therapeutic results in selected patients, even in the presence of severe circumferential stenoses.     

Surgical treatment for Zenker’s diverticulum: comparison between diverticulectomy and diverticulopexy

Background

The ideal surgical technique for symptomatic Zenker’s diverticulum has not been identified yet. Endoscopic treatment, although frequently performed, has not replaced the open cricopharyngeal myotomy, which is still deemed the standard therapy by many dedicated physicians. The management of the diverticular sac after myotomy is still a matter of debate. The aim of this study is to compare the results of diverticulectomy and diverticulopexy after cricopharyngeal myotomy, in homogeneous groups of patients.

Methods

Thirty-seven patients were treated for Zenker’s diverticulum at the same university medical school, but in two different units, with open cricopharyngeal myotomy, associated with diverticulectomy in 17 patients and with diverticulopexy in the remaining. No clinical criteria influenced the different choice of treatment of the diverticular pouch, but only the surgeon’s preference. Clinical data, diverticulum size, postoperative course, and complications were analyzed. Patients were followed up for median duration of 37 months (range 12–113 months) through contrast swallow study and clinical evaluation, aided by a specifically conceived questionnaire. Records were analyzed by Mann–Whitney–Wilcoxon test and Fisher’s exact test.

Results

Homogeneous comparative values for sex, age, diverticulum size, and symptoms were found in the two groups. Statistical analysis indicated that diverticulopexy, as compared with diverticulectomy, allowed reduced postoperative complications and slightly improved long-term swallowing.

Conclusions

Diverticulopexy is feasible also in large Zenker’s diverticula and can achieve equivalent or even better results than diverticulectomy with a smoother postoperative course.

     

Isolated cardiophrenic angle node metastasis from ovarian primary. report of two cases

Ovarian cancer is the most lethal gynaecologic malignancy. It usually spreads out of the abdomen involving thoraco-abdominal organs and serosal surface. This disease is poorly curable and surgery, at early stage, is supposed to achieve the best survival outcome. In systemic dissemination, chemiotherapy is indicated, sometimes with neoadjuvant aim. The most common clinical expressions of advanced ovarian carcinoma are multiple adenopathy, neoplastic pleuritis, peritoneal seeding and distant metastasis, mainly hepatic and pulmonary. Isolated adenopathy of the mediastinum is rare and isolated bilateral have never been described before. We report two cases of isolated bilateral cardiophrenic angle lymphnode metastasis from ovarian carcinoma, without peritoneal and pleural involvement. Both patients were successfully resected through minimally invasive thoracic surgery. About the role of surgery, few data are available but survival seems to be longer after resection thus, more investigation is required to make the indication to surgery more appropriate in advanced cases.     

Recipient intramuscular cotransfection of transforming growth factor beta1 and interleukin 10 ameliorates acute lung graft rejection

OBJECTIVE: Multiple gene transfer might permit modulation of concurrent biochemical pathways involved in acute lung graft rejection. We investigated whether gene cotransfection into the recipient reduces acute lung graft rejection. METHODS: Brown Norway rats were used as donors, and F344 rats were used as recipients. Recipient animals were injected with saline (groups I/VI) or 1 x 10(10) pfu of adenovirus encoding beta-galactosidase (groups II/VII), transforming growth factor beta1 (groups III/VIII), interleukin 10 (groups IV/IX), or both transforming growth factor beta1 and interleukin 10 (groups V/X) into both leg muscles 2 days before transplantation (groups I-V) or at the time of harvest (groups VI-X). The Kruskal-Wallis test for rejection score and 1-way analysis of variance were used to compare groups. RESULTS: Oxygenation was significantly improved in the cotransfected groups treated 2 days before transplantation and at the time of harvest. Rejection scores were also reduced in the cotransfected groups. In group V cotransfection suppressed endogenous interleukin 2 but not interferon gamma and tumor necrosis factor alpha. CONCLUSION: Recipient intramuscular cotransfection of transforming growth factor beta1 and interleukin 10 suppressed interleukin 2 expression and provided a synergistic effect that reduced acute lung graft rejection. This approach might be applied to the clinical setting because transplant recipients could be treated at the time of implantation.     

Acute mediastinitis: clinical features and review of a case load

The term acute mediastinitis describes a number of clinical conditions, usually secondary to diseases of other aetiology with which they tend to share the severity of the clinical picture. In these situations even a timely diagnosis and adequate therapeutic management are not always enough to ensure healing. Over the period 1987-2002 15 patients with acute mediastinitis were observed (8 male, 7 female), aged from 22 to 90 years (mean age: 57.9), distributed as follows: descending necrotising mediastinitis, 4 cases; iatrogenic oesophageal rupture, 2 cases; iatrogenic tracheal rupture, 3 cases; oesophageal perforation (foreign body), 4 cases; Boerhaave's syndrome, 1 case; oesophageal perforation (lye ingestion), 1 case. All patients except one--managed medically--were submitted to mediastinal drainage (surgical or by mediastinoscopy), combined with cervical debridement and drainage in cases of descending necrotising mediastinitis, alimentary tract diversion (cervical oesophagostomy + feeding jejunostomy + gastric decompression) in cases of large oesophageal lesions or if the lesion occurred more than 24 hours before observation, and uni- or bilateral tube thoracostomy. Furthermore, antibiotic therapy was always administered, initially choosing broad-spectrum medications, and subsequently adjusting according to bacterial cultures. Four patients died. In 4 cases (2 descending necrotising mediastinitis, 2 acute mediastinitis secondary to oesophageal perforation) repeated interventions were necessary in order to drain pleural or mediastinal effusions. Acute mediastinitis remains a serious clinical entity, the outlook of which is often poor. Factors influencing outcome are the patient's age and general condition (adequate immune response), a timely diagnosis, preoperative localisation of effusions, an aggressive therapeutic approach including drainage of infection sites in the mediastinum, neck and/or pleural cavities, alimentary tract diversion in cases of oesophageal lesions observed late, adequate antibiotic therapy, and nutritional support (total parenteral/enteral nutrition).     

脉络丛乳头状瘤术后放射治疗4例报告和文献复习

目的　报告４ 例脉络丛乳头状瘤（ Ｐ Ｃ Ｐ） 术后放射治疗结果，复习相关文献，探讨间变型脉络丛乳头状瘤（ Ｐ Ａ Ｃ Ｐ） 病理诊断标准和放射治疗在脉络丛肿瘤治疗中的作用。方法　作者对４ 例术后残存的第４ 脑室脉络丛肿瘤行瘤床局部放射治疗。放射治疗采用６ 或８ Ｍ Ｖ Ｘ 线，靶区包括术前 Ｃ Ｔ 显示瘤床外１ ～２ ｃ ｍ ，常规分割， Ｄ Ｔ４０ ～５５ Ｇｙ 。复习１９７５ 年以来的部分相关文献。结果　１ 例疗后失随。３ 例经２ 年随访，１ 例成人无复发，正常工作生活；２ 例儿童分别于疗后２１ ，２４ 个月野内复发，其中１ 例（ 例３） 伴广泛脑脊膜种植转移。结论　脉络丛肿瘤的病理诊断与其临床生物学行为不完全一致， Ｐ Ａ Ｃ Ｐ病理诊断标准有待完善。绝大多数 Ｐ Ｃ Ｐ 可经手术彻底切除治愈； Ｐ Ａ Ｃ Ｐ 术后应行全脑全脊髓放射治疗。     

Postoperative radiotherapy for resected pathological stage IIIA-N2 non-small cell lung cancer: a retrospective study of 221 cases from a single institution

Background.

For patients with resected pathological stage IIIA–N2 non-small cell lung cancer (NSCLC), the role of postoperative radiotherapy (PORT) is not well defined. In this single-institutional study, we re-evaluated the effect of PORT on overall survival (OS) as well as tumor control in this subgroup of patients.

Methods.

In 2003–2005, 221 consecutive patients with resected pathological stage IIIA–N2 NSCLC at our institution were retrospectively analyzed in an institutional review board–approved study. The effect of PORT on OS, cancer-specific survival (CSS), and disease-free survival (DFS) was evaluated using the Kaplan–Meier method and log-rank tests. The impact of PORT on locoregional control and distant metastasis was also analyzed.

Results.

Compared with the control, patients treated with PORT had a significantly longer OS time (χ², 3.966; p = .046) and DFS interval (χ², 6.891; p = .009), as well as a trend toward a longer CSS duration (χ², 3.486; p = .062). Patients treated with PORT also had a significantly higher locoregional recurrence-free survival rate (χ², 5.048; p = .025) as well as distant metastasis-free survival rate (χ², 11.248; p = .001). Multivariate analyses showed that PORT was significantly associated with a longer OS duration (p = .000).

Conclusions.

PORT can significantly improve the survival of patients with resected pathological stage IIIA–N2 NSCLC. A prospective randomized multicenter clinical trial is ongoing.