Outcome of TiNi stent treatments in symptomatic central airway stenoses caused by Aspergillus fumigatus infections after lung transplantation.

BACKGROUND: Central airway stenoses due to Aspergillus fumigatus infections have been a significant cause of morbidity and mortality after lung transplantation. We reviewed our experience using self-expandable braided TiNi-metallic stents in the management of 4 single-lung transplant recipients with central airways stenoses between January 2003 and June 2010. METHODS: Thirty-six single-lung transplant recipients were subjected to pulmonary function testing and surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Bronchial wash fluid and biopsy material were examined by appropriate fungal stain and culture techniques. RESULTS: Nine of 36 patients (25%) were diagnosed with Aspergillus fumigatus infections; 4 (11.1%) showed rapid decrease in pulmonary function and developed severe upper airway narrowings with about 80% of the central airway obstructed by thick plugs of mucus, heavily laden with Aspergillus species. All 4 patients were managed with stent placement as well as antifungal treatments and showed a forced vital capacity and forced expiratory volume in 1 second improvement of 11.3% and 25.9%, respectively after 1 month. CONCLUSIONS: TiNi stent applications in combination with antifungal drugs are sufficient to treat central airway stenoses after lung transplantation.

Survival and outcomes of surgical treatment of the elderly NSCLC in China: a retrospective matched cohort study.

AIM: To compare survival and outcomes of pulmonary resection for elderly NSCLC patients with that of younger controls in China. METHODS: A database which included 4792 NSCLC patients who received complete surgery from 1985 to 2005 was used. The elderly patients (>or=70) were matched 1:1 to controls (<70) by 5 variables: gender; stage; histology; pulmonary resection types; adjuvant chemotherapy. The long-term survival rates, the operative mortality and short-term death after surgery were compared. RESULTS: There were 1304 patients: 652 cases were >or=70. The 5-year OS of elderly was 39%; that of the controls was 45% (p=0.06). Operative mortality rate between elderly and the controls was similar (9/652 vs 4/652 p=0.16) but the short-term death within 2 months after the surgeries were different (23/652 vs 7/652 p=0.003). The elderly with lobectomy had a worse 5-year OS than controls (42% vs 46% p=0.05), but the 5-year OS was similar for patients who received pneumonectomy (24% vs 36% p=0.40) and the limited resections (46% vs 39% p=0.27). The 5-year OS in patients who received adjuvant chemotherapy were similar (49% vs 44% p=0.10). CONCLUSION: Elderly have the similar long-term OS with the controls. They should not be denied the curative surgery and adjuvant chemotherapy based on their chronologic age. However, elderly patients had a higher risk of short-term death after the surgery, which suggests that elderly be given more intensive care after the surgery.

[Long-term result of surgical management of metastatic neoplasms to the lungs].

We reviewed the role of pulmonary resection for metastatic pulmonary lesions in our hospital. Over a 25 year period, 58 patients underwent 61 thoracotomies. Pulmonary resections were done in 56 patients. Two were done by explorations and one of them was only for diagnostic purpose. The operative mortality was 6.6% (< 30 days). Long-term follow-up in 45 patients whose primary tumor was controlled and secondary tumor was resected revealed 1, 3, and 5 year accumulative survival rates of 76.8%, 37.9% and 18.0% respectively. Patients with multiple pulmonary metastases resulted in lower survival rates than solitary lesions (P < 0.05). Postoperative survival rates were also found to be affected by the tumor doubling time (r = 0.8460). The surgical indications for secondary lung tumor were discussed.

[Indication for emergency pulmonary resection in patients with massive hemoptysis].

Emergency pulmonary resection was done in 24 patients with massive hemoptysis from January 1983 to December 1992. The curative, morbidity and mortality rates were 95.8%, 16.6% and zero respectively. Above mentioned result was better than that of the author's report in 1986. It was shown that emergency lung resection should be active when the drug therapy failed, the site of hemoptysis was clear, the lung lesion was localized and the general condition and cardiopulmonary function was good, especially the cases had a history of suffocation, hypotension or shock. In spite of the present result of emergency lung resection for massive hemoptysis tends to be better, the operative complication is still higher than routine pulmonary resection. Therefore, the operative indication should be strictly handled. For cases whose surgical indication is inadequate, bronchial arterial embolization is an effective and relative safe method.

Bednar tumor (pigmented dermatofibrosarcoma protuberans). An analysis of six cases.

Six cases of Bednar tumor were analyzed clinicopathologically along with a review of 39 published cases. The findings were then compared with data on 44 cases of ordinary dermatofibrosarcoma protuberans (DFSP) obtained from our files. The clinical manifestations of the patients and the anatomic locations of the tumors were similar between the two categories, but the rate of recurrence was lower in cases of Bednar tumor. The histologic pattern of Bednar tumor was indistinguishable from ordinary DFSP except for scattered melanosome-containing cells. Ultrastructural and immunohistochemical examinations showed no evidence of neuroectodermal differentiation of dominant spindle-shaped cells in Bednar tumor, supporting a fibroblastic line of differentiation. The origin and pathogenesis of the melanosome-containing cells were considered. These cells failed to react with HMB-45, a melanoma-specific antibody, and the large majority of melanosomes present were mature or at Stage IV, plus a few immature ones at Stage II. These pigmented cells do not appear to be neoplastic, and cannot be used as proof to indicate that Bednar tumor is a neuroectodermal neoplasm.

[Palliative pulmonary resection for primary lung cancer].

From January 1961 through December 1984, 253 of 2048 patients who have undergone surgical treatment for primary lung cancer were retreated by palliative pulmonary resection. The indications of palliative resection were: there was partial carcinoma or metastatic lymph node left in the thorax; microscopically, residual tumor was found on bronchial stump margin. Operation modes: partial pulmonary resection 135, total pneumonectomy 118. Postoperative complications occurred in 25 cases and 17 died in the hospital with in 30 days. 236 cases were followed-up for 1 to 21 years. The 1-year, 3-year and 5-year survival rates after operation were 51.3%, 13.1% and 8.1% respectively. The survival rates after palliative pulmonary resection for squamous and adenocarcinoma were higher than thoracotomy but the survival rates of large undifferentiated, small cell and mixed cancer were similar to those of thoracotomy. Besides, patients who had both subcarinal lymph node involvement and incomplete excision in resection had the worst prognosis. The authors consider that squamous and adeno carcinoma of the lung are the main indication for palliative resection. Subcarinal lymph nodes must be excised as much as possible while operation, otherwise local radiation and/or chemotherapy should be performed after operation.

[Lung cancer in the young adult and results of surgical treatment].

Sixty patients with primary lung cancer and under 40 years of age were operated from Jan. 1960 to June 1983. It comprised 3.7% of 1,635 lung cancers in all during the same period. The average age was 34.4 (17-39) years old. 35 were male and 25 female with a sex ratio of 1.4:1 which was lower than that reported for all lung cancers. Of the 60 patients, 31 (51.7%) presented with cough, 27 (45%) with bloody sputum, 23 (43.3%) chest pain and 13 (21.7%) feverishness. The average delay before the first medical examination was 6.4 months. It was over 1 year in 8 patients. The misdiagnosis rate was 76.7%. According to the TNM classification, the lesions were: stage I in 16.7%, stage II in 23.3% and stage III in 60%. By pathology, 45% were adenocarcinoma, 25% squamous cell carcinoma, 23.3% undifferentiated carcinoma and 6.7% squamous-adenocarcinoma. The resection rate was 83.3% (50 patients). The 1, 3, 5, 7 and 10 year survival rates were 83.3%, 42.5%, 32.3%, 18.5% and 21.1% which show that the survival rate of lung cancer in the young adults was similar to that of all ages. Most of the patients treated only by exploration died within 1.5 years. The authors believe that early diagnosis, early resection supplemented by radiotherapy, chemotherapy and immunotherapy might improve the survival rate of lung cancer in the young adults.