Free space millimeter wave-coupled electro-optic high speed nonlinear polymer phase modulator with in-plane slotted patch antennas.

We report in-plane slotted patch antenna-coupled electro-optic phase modulators with a carrier-to-sideband ratio (CSR) of 22 dB under an RF power density of 120 W/m(2) and a figure of merit of 2.0 W(-1/2) at the millimeter wave frequencies of 36-37 GHz based on guest-host type of second-order nonlinear polymer SEO125. CSR was improved more than 20 dB by using a SiO(2) protection layer. We demonstrate detection of 3 GHz modulation of the RF carrier. We also derive closed-form expressions for the modulated phase of optical wave and carrier-to-sideband ratio. Design, simulation, fabrication, and experimental results are discussed.

5-year prospective results of trimodality treatment for malignant pleural mesothelioma.

AIM: Even though followed by a prolonged survival in highly selected patients, the promising results of Sugarbaker's trimodality treatment for malignant pleural mesothelioma (MPM) are debated and not yet uniformly replicated. The purpose of this study is to evaluate prospectively the reproducibility of the trimodality treatment results in a patient population with mesothelioma staged by the IMIG classification. METHODS: Fifty-four patients with MPM have been judged candidable to extended pleuropneumonectomy (EPP), to be followed by chemotherapy (paclitaxel+carboplatin) and radiotherapy (50 Gy). RESULTS: At thoracotomy, 44 of the 54 surgical candidates (81%) underwent EPP; 73% of the operated patients completed the entire adjuvant chemo-radiotherapy with no major toxicity. The 30-day or in-hospital operative mortality rate was 4.5% (2 deaths), the major morbidity 36%, and the overall complication rate 50%. At 5 years the projected survival of the 42 surgical survivors submitted to EPP is 19%; median survival is 20 months. The restricted group of patients with epithelial, N0-1, completely resected MPM (microscopic negative margins) exhibits a projected 50% 5-year survival. Clinical understaging has shown up to be noticeable both at the thoracotomy exploration and pathology examination. Most of the disease recurrences are loco-regional and the current insufficiency of intraoperative or postsurgical radicality needs improvement, along with earlier diagnosis, more accurate staging, and preoperative induction for the multimodality treatment of pleural mesothelioma to become an established curative option. CONCLUSIONS: This series confirms the reproducibility of the trimodality treatment for MPM,which is associated with prolonged survival for early-stage tumors at the cost of a not prohibitive treatment-related mortality rate.

Vascular Thoracic Outlet Syndrome staging and treatment.

Thoracic Outlet Syndrome (TOS) is a well known lesion. Sophisticated imaging techniques can clearly highlight any anatomical damage and a wide range of therapeutic choices are available. It would seem obvious that any given patient should obtain the same treatment irrespective of the medical institution he contacts, but this is not the case. Instead each specialist may recommend different treatments: physiatrist, neurologist, surgeons (thoracic, vascular, neuro, orthopedic). Everyone preserves his specific language and there is no univocal treatment plan consensus for this complex syndrome. Evidently, the correct staging of TOS is still an unresolved question. In order to solve this problem, we collected all clinical and instrumental aspects of the syndrome into a clear, precise classification. Similar to TNM staging of malignant diseases, we used a grouping model based on the three mainly involved anatomical structures: N (= Nerves; brachial plexus and sympathetic fibers), A (= Artery; subclavian-axillary), V (= Vein; subclavian-axillary). We named it the NAV staging of TOS. A retrospective examination of our case records confirmed a valid and useful correlation between the proposed NAV staging and the therapeutic procedures that were actually applied. It is now essential to perform a multi-centre study to extend the validity of our staging.

Extrapleural bullectomy or lung volume reduction: air tight surgery for emphysema without strip-patch.

Air leaks after stapled lung resections for emphysema remain the most common postoperative complication. Staple line reinforcement, alone or in association with a parietal pleural tent, is recognised as an effective technique for decreasing the occurrence of air leaks after pulmonary wedge resection. Several materials have been employed for reinforcement, most of them prosthetic and costly. We use the parietal pleural tent covering the pulmonary targets to be excised, as a reinforcement on which the staple is fired (2 LVRS and 6 bullectomy procedures). Air tightness and obliteration of intrapleural space are simultaneously achieved. We named our technique: Extrapleural Bullectomy (EB) or Extrapleural Lung Volume Reduction (ELVR), according to the indication of the operation. No mortality nor significative morbidity, particularly prolonged postoperative air leak, were observed. At the follow-up (3 to 12 months) no pneumothorax or residual spaces have occurred.

Pediatric thyroid nodules: management in the era of fine needle aspiration.

BACKGROUND/PURPOSE: Thyroid nodules are rare in children. The need to uncover malignancy is the most challenging dilemma in management. The aim of this report was to determine whether management of pediatric thyroid nodules has changed in the era of fine-needle aspiration (FNA) cytology. METHODS: Twenty-four children with thyroid nodules comprised the study group. Demographic characteristics, clinical manifestations, imaging results, FNA cytology results, surgical therapy, complications, and pathological reports were reviewed retrospectively. FNA cytology results were categorized as either benign, malignant, suspicious, or insufficient. RESULTS: Girls outnumbered boys (five to one) with a mean age of 14.9 years. Nineteen nodules were benign and five malignant. Malignancy was characterized by localized tenderness, multiglandular appearance, and fixation to adjacent tissues. Ultrasound scans and nuclear scans gave no clue toward management because cystic, hot, and warm nodules figured among malignant cases. FNA in 18 children achieved 80% accuracy, 60% sensitivity, 90% specificity, 75% positive, and 81% negative predictive value. Physical examination findings, persistence of the nodule, and progressive growth decided for surgery in most children. CONCLUSIONS: FNA is a safe adjunctive test that plays a minor role in the decision to withhold surgery. Its greatest strength is to resolve, in case of suspicious or malignant cytology, that a more radical procedure will be needed. Clinical judgement as determined by serial physical findings continues to be the most important factor in the management of thyroid nodules in children.

Bronchiolitis obliterans organizing pneumonia secondary to amiodarone: clinical, radiological and histological pattern.

The most common lung tissue reaction to amiodarone toxicity is a nonspecific pulmonary chronic interstitial pneumonia. In a minority of patients diffuse alveolar damage, alveolar haemorrhage or bronchiolitis obliterans organizing pneumonia (BOOP) is encountered. We report the case of a patient with clinical, functional, radiological and histological signs of BOOP secondary to amiodarone. The condition was partially reversible after suspending drug treatment, and resolved after corticosteroid treatment without relapse after a 14 month follow-up.

Pulmonary dirofilariasis in man: a new Italian case. Review of the European literature.

In June 1991 a 62-year-old retired man, from Udine (northern Italy), was suddenly affected by dyspnoea. X-ray and CT control detected a coin lesion in the lung, in May 1992 this lesion was removed surgically. Histological examination revealed the presence of a nematode inside an arteriole which had provoked a small infarct in the pulmonary tissue. The parasite presented marked regressive phenomena that made an accurate morphological analysis impossible. However, in the light of certain details of the cuticle, and by analogy with four similar cases occurring in northern Italy, as well as 10 others (nine subcutaneous and one submucosa) reported in man from the same region (Venetia) over the last 15 years, the aetiologic agent was thought to be Dirofilaria (N.) repens. Over all 10 cases of human pulmonary dirofilariasis were reported in Europe: five in Italy, probably by D (N.) repens, two in Germany, in patients coming from Corsica and two in Spain (only by serology), attributed to D. immitis. In addition one case was reported in U.S.A. in a man who previously visited Italy.

Epidermal growth factor receptor in lung malignancies. Comparison between cancer and normal tissue.

Epidermal growth factor receptors (EGFr) were measured using a radioligand binding assay, in membrane preparations from 51 human non-small cell lung cancers and in normal tissue of the same patients. The binding characteristics of EGFr were similar in tumour and normal lung membranes (range of dissociation constant of high affinity sites: 0.1-0.6 nM). However, the concentrations in tumours (median, 16.4 fmol mg-1 of protein; range, 1.5-176) were significantly higher than in normal tissues (median, 7.4 fmol mg-1 of protein; range, 1.9-13.4). The receptor levels in normal tissue were normally distributed. It was therefore possible to define a normal/pathologic cut-off level (12.9 fmol mg-1 of protein). In 57% of cases EGFr in cancer was higher than the cut-off. No relationships were found between receptor concentrations and positivity rates of EGFr and histology, stage, lymph node positivity and pT. A trend for a direct relation between receptor positivity and grading was found.

[Human pulmonary dirofilariasis. A third case in Italy]. / Dirofilariasi polmonare nell'uomo. Un terzo caso in Italia.

A new case of Human Pulmonary Dirofilariasis, the third in Italy, is described. It occurred in August 1990 in a 66 years old man, living in San Donà di Piave (province of Venice). The pulmonary infarctual lesion caused few symptoms and was discovered by chance during a chest X-ray examination as a coin lesion and suspected to be of a neoplastic origin. The histological findings allowed the exact diagnosis, identifying the causal agent as Dirofilaria probably repens, a nematode common parasite of dogs in the Old World and recognised agent of over 90 human cases of Subcutaneous Dirofilariasis reported in Italy. The parasite was an immature male in advanced regressive conditions. It was inside the lumen of a small artery, surrounded by necrotic-phlogistic tissue with granulomatous giantcellular aspects of the foreign body type. Some questions are raised by the authors in relation to the presence of human cases by D. repens and not by D. immitis (dog heartworm) in areas of Italy where this last species is much more prevalent than the former in canine populations; to the fact that the 3 Italian pulmonary cases (which are the only ones reported in Europe) happened in the same restricted geographic area (Veneto and Emilia-Romagna regions); and finally to the fact that all the 3 cases occurred in elderly people.

[The radiological picture of the nonvascular surgical mediastinum]. / Il quadro radiologico del mediastino non vascolare operato.

A review was made of the chest X-ray features of 120 patients who underwent surgical treatment for mediastinal nonvascular pathologies over the past 12 years in the Mestre Hospital. A method of analysis is proposed which takes into account not only the differences between the immediate postoperative period and the follow-up, but also the anatomotopographic partition and the surgical practice. Normal and pathological patterns for both of the above periods are described. The "dimness" of the aerial tracheogram is emphasized as a useful and early sign of mediastinal recurrence.

[Diagnostic and therapeutic approach to lung neoplasms. Departmental experience at the Mestre Hospital]. / L'approccio diagnostico e terapeutico alle neoplasie polmonari. Esperienza dipartimentale dell'Ospedale di Mestre.

The results are reported of a multidisciplinary diagnostic and therapeutic program applied to 381 patients with lung carcinoma from 1983 through 1985 at Mestre General Hospital. Cytologic and/or histologic diagnosis was established in 95% and staging accomplished in 96% of the patients. One-hundred-twenty-nine patients with non-small cell cancer were primarily treated by surgery (lobectomy or pneumonectomy); 3-year survival of this group was 48%. Of the 45 patients with pN1 or pN2 disease, 23 were treated with postoperative adjunctive mediastinal radiotherapy (50Gy/25 F/5Wk); however, survival showed no significant difference in the two groups. Ninety-seven inoperable patients were treated by radiotherapy alone; among those receiving doses of 50-60 Gy in 5 to 6 weeks, 3-year survival was 10%. Chemotherapy (CAMP), used in 23 cases (22 stage IV, 1 stage III), showed no improvement in survival, as compared with a similar series of patients submitted to symptomatic treatment alone. Of the 27 patients affected by small-cell carcinoma, 14 were treated with an aggressive radiochemotherapy protocol and 13 with palliative radiotherapy or low-dose chemotherapy: median survival in the two groups was respectively 45 and 60 weeks. Our study demonstrates the clinical feasibility of interdisciplinary programs routinely applied to a large population of lung cancer patients, and confirms its rationale in terms of early diagnosis, improved staging, and adequate treatment.

[Respiratory function in uremic patients before and after dialysis]. / La funzionalità respiratoria in pazienti uremici prima e dopo dialisi

Respiratory function investigations (spirometry, capillary haemogasanalysis and Xenon 133), before and after dialysis, have been carried out in 10 uraemic patients. Methods of investigation and the results showing a post-dialysis improvement of the lung ventilation and perfusion function, are described.

[Respiratory function in liver cirrhosis. Spirometry, blood gas analysis and radioisotope study with Xenon 133]. / La funzionalità respiratoria nella cirrosi epatica. Ricerca spirometrica, emogasanalitica e radioisotopica con Xenon 133

The literature data concerning respiratory function in cirrhosis of the liver are cited and reference is made to the results of a spirometric, gas analysis and 133-Xenon investigation of this parameter in 38 patients. Spirometry pointed to slight ventilatory incapacity of the restrictive type. Arterial gas analaysis showed respiratory alkalosis, usually accompanied by metabolic acidosis and slight hypoxyaemia. Examination with 133-Xe indicated that hypoxyaemia was not due to a shunt effect, since there was no excess of perfusion with respect to district ventilation. It was clear, on the other hand, that the pulmonary capillary reserve was almost exhausted. Such complete perfusion of the capillary bed may be due to increased cardiac output and, in part, to reduction of the respiratory surface caused by raising of the diaphragm and hypoventilation of the lung bases.