Histopathological grading of response to induction chemotherapy in non-small cell lung cancer: a preliminary study.

Management of locally advanced NSCLC is controversial. Induction chemotherapy followed by surgery has become an accepted approach for Stage III disease. However, the clinical assessment of the efficacy of preoperative treatment is inaccurate. We propose a four-grade histopathological evaluation of the response to chemotherapy based on the analysis of 20 evaluable cases and compared with clinical outcome. Follow-up ranged from 12 to 68 months. Correlation between different grading of necrosis and survival is statistically significant. Based on these preliminary results, we suggest that grading of response is a valid parameter to evaluate standard regimens and novel drug associations in larger trials.

Ten years' experience in heart valve replacement with artificial prostheses: immediate and long-term results in 1812 cases.

A ten year follow up of 1,812 patients who underwent heart valve replacement with artificial prothesis between October 1963 and December 1973 is reported. Hospital mortality was 8.5% for aortic valve replacement; 13.6% for mitral valve replacement and 19.3% for multiple valve replacement. Late mortality was 13.3% for aortic valve replacement; 25.7% for mitral valve replacement and 25.9% for multiple valve replacement. The survival rate of the different groups of patients were actuarially determined. The survival rates following replacement of the aortic valves was 81% after 9 years. The main late complications are embolism and valve leakage. All surviving patients show a clinical improvement, particularly in the groups of isolated aortic a mitral valve replacement. The heart size reduction after operation has been measured. This is more evident 6 months after surgery: the average reduction was 23% after aortic valve replacement and 20% after mitral valve replacement.

[Surgical correction of pectus excavatum]. / Correzione chirurgica del pectus excavatum.

From 1979 to March 1993 a corrective surgical operation was performed on 14 patients with pectus excavatum. Patients' age ranged between 11 and 23, (mean value 16); 11 were males and 3 females with family history of deformities of the thoracic wall in 5 cases and scoliosis in 8. In 11 patients the defect was present at birth or during the first year of life. At present, the following examinations are carried out routinely: X-ray of the chest in the two standard positions and of the backbone, spirometry and ECG in standard conditions and under stress, Doppler echocardiogram, CT, psychomotor and intellectual behaviour test. Indication to surgery was for marked deformity and resulting cardiorespiratory physiopathologic repercussions present or expected in future. The surgical technique performed, a modification of the Ravitch procedure, was sternochondroplasty. A temporary stabilization support was added in 9 patients between the age of 16 and 23 (Rehbein plates in 3, sliding staplesplints in 6) so as to prevent secondary depressions. There were no deaths in this series. Cosmetic results were satisfactory with disappearance of a psychosomatic troubles.

[Surgical stabilization of post-traumatic flail chest. Our experience with 116 cases treated]. / La stabilizzazione chirurgica del lembo costale mobile post-traumatico. Nostra esperienza relativa a 116 casi trattati.

The therapeutic approach in a patient with traumatic flail chest is varied and controversial, both as regards the type of treatment and as regards the surgical techniques to be employed. The authors have examined 116 cases of flail chest treated surgically; these represented 17.7% of the 655 chest traumas operated in the period from July 1975 to March 1993. Increasing experience has reduced indications for surgery: at present it is not performed in cases of serious craniocerebral lesions, of severe pulmonary contusions, or, however, when mechanical ventilation is required. As for surgical techniques, external traction was applied in the first 15 cases treated but then discontinued because of the poor outcome. Osteosynthesis (77 cases), associated with thoracotomy, was carried out with Kirschner wires, Vecsei metal plates, Judet agraffe, alone or variously combined. Recently, a less aggressive personal technique has been employed prevalently: Kirschner wires placed vertically within the chest, bridging between one rib (generally the V or VI, well fixed with metal plates), and the clavicle and/or sternum. The overall mortality rate, prevalently due to associated lesions, was 20.6%. Excluding emergencies, these patients should be operated in deferred emergency within 24-48 hours of trauma. Osteosynthesis, when indicated is the procedure offering the greatest assurance of success. The authors believe that, in selected cases, surgical stabilization is necessary.

[Pulsating tumor of the sternum: enlarged exeresis and reconstruction with marlex-methylmethacrylate prosthesis]. / Tumore pulsante dello sterno: exeresi allargata e ricostruzione con protesi di marlex-methyl-methacrylate.

The authors report on a rare case of pulsating tumor of the sternum. En bloc resection was carried out with removal of the sternal manubrium and body, tracts of the I-II-III rib with the intercostal muscles and part of the left pectoralis major. Reconstruction of the thoracic wall was performed with a marlex MMA sandwich prosthesis. From a histological viewpoint, the carcinoma was well differentiated and compatible with thyroid primitivity. Non complementary antiblastic therapies were provided as all the examinations carried out were negative and the intervention was radical. The patient had been followed-up with serial controls and three complete stagings at one, three and five years after intervention (CT, echography and function tests of the thyroid, bone scintigraphy). At follow-up of more than six years the patient is doing well and is event free. The authors believe, even with the help of reports from the literature that, in sternal metastases from thyroid carcinomas, especially when single and large, surgical therapy is required.