Advanced anal squamous cell carcinoma -- radiotherapy or surgery?

BACKGROUND: Anal and rectal cancers occupy the third position of death causes in Poland. Adenocarcinoma is the most frequent among the tumours in this group. Squamous cell carcinoma can be relatively less common. This kind of carcinoma may rather affect the anus than the rectum. Although the lesion is perceived as not very malignant and as such responsive to radiant energy therapy, some cases may require surgical treatment. METHODS: Within 1999-2008 (the observation period of 10 years) there were 18 patients treated for anal squamous cell carcinoma at the Department of Thoracic Surgery, General and Oncological Surgery of the Medical University of Lodz, at the Surgical Department of the Ministry of Interior and Administration Hospital in Lodz and at the Teleradiotherapy Department of Mikolaj Kopernik Voivodship Specialist Hospital in Lodz. Each patient underwent radiochemotherapy with Mitomycin and 5-Fluorouracil and Lucovorin. The applied radiation doses ranged between 45-54 Gy in eighteen 2.0 Gy fractions. The abdomino-perineal resection of the rectum (APR) was performed in 3 patients (16.5%) who did not show full regression of the carcinoma. In all three cases the histopathological diagnosis preceded the surgical procedure. RESULTS: For the total number of 18 patients with anal squamous cell carcinoma the mean observation period was 5.5 years, in the group of the operated patients the mean survival rate was 48 months (the median of 14-74 months) while for the group of the patients treated conservatively the mean survival rate amounted to 55 months (the median of 17-82 months, p=0.23). The mean 5-year disease-free survival rate was rather similar to the same rate of the general group, whereas the post-operative complications occurred in 66% of surgical procedures and 27% of teleradiotherapeutic procedures. CONCLUSIONS: Combined radiotherapy and chemotherapy can be the method of choice in treating anal squamous cell carcinoma. Surgery should be used in advanced cases, when complete regression on radiochemotherapy cannot be observed. The abdomino-perineal resection of the rectum is the kind of a procedure that may be accompanied with a vast number of complications. Nevertheless, it still remains a necessary therapeutic method in the described cases.

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer.

INTRODUCTION: The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. MATERIAL AND METHODS: The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished--29 patients and those with malnutrition--31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. RESULTS: Patients qualified for particular groups differed significantly in age, p<0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05±0.27 g/l, 1.764±0.27 g/l, 68.90±6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32±2.92 g/l (p<0.005). The average percentage weight loss in both groups differed significantly 0.111±0.044 vs. 0.031±0.028 at p<0.0005. In the group of malnourished patients the right hand average strength was 26.52±8.06 kg and the left one amounted to 25.35±6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93±11.27 kg, 32,37±11.72 kg, p<0.001. The tapping test average time of the right hand was 19.24±4.04 vs. 16.72±3.06 and of the left one 19.69±3.59 kg vs. 17.48±2.79 kg and were significantly longer in patients suffering from malnutrition (p<0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50±0.08 s vs. 0.45±0.087 s, (p<0.05) and for auditory one 0.43±0.08 vs. 0.39±0.08 s (non significant). CONCLUSIONS: Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement.

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer / Índices bioquímicos y funcionales de malnutrición en pacientes con cáncer no microcítico de pulmón operable

Introduction: The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. Material and methods: The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished - 29 patients and those with malnutrition- 31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. Results: Patients qualified for particular groups differed significantly in age, p < 0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05 ± 0.27 g/l, 1.764 ± 0.27 g/l, 68.90 ± 6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32 ± 2.92 g/l (p < 0.005). The average percentage weight loss in both groups differed significantly 0.111 ± 0.044 vs. 0.031 ± 0.028 at p < 0.0005. In the group of malnourished patients the right hand average strength was 26.52 ± 8.06 kg and the left one amounted to 25.35 ± 6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93 ± 11.27 kg, 32,37 ± 11.72 kg, p < 0.001. The tapping test average time of the right hand was 19.24 ± 4.04 vs. 16.72 ± 3.06 and of the left one 19.69 ± 3.59 kg vs. 17.48 ± 2.79 kg and were significantly longer in patients suffering from malnutrition (p < 0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50 ± 0.08 s vs. 0.45 ± 0.087 s, (p < 0,05) and for auditory one 0.43 ± 0.08 vs. 0.39 ± 0.08 s (non significant). Conclusions: Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement (AU)

Introducción: El propósito de este estudio fue evaluar el impacto del estado nutricional de pacientes con cáncer no microcítico de pulmón sobre el rendimiento psicomotor, la fortaleza muscular y la actividad funcional. Material y métodos: el estudio incluyó 60 pacientes consecutivos ingresados en la clínica para tratamiento quirúrgico por histología comprobada de cáncer de pulmón no microcítico. Se dividió a los pacientes, dependiendo del estado de pérdida de peso, en dos grupos: pacientes relativamente bien nutridos -29 pacientes, y aquellos con malnutrición- 31 pacientes. Se anotaron cuidadosamente la historia, la exploración física, los datos antropométricos, los parámetros bioquímicos y las pruebas funcionales. Resultados: los pacientes que se clasificaban en grupos concretos diferían significativamente con respecto a la edad, p < 0,002. Los valores promedio de albúmina, transferrina y proteínas totales de los pacientes bien nutridos estaban dentro de los rangos adecuados. En los pacientes malnutridos, estos valores fueron, respectivamente: 34,05 ± 0,27 g/l, 1,764 ± 0,27 g/l, 68,90 ± 6,39 g/l, siendo las diferencias estadísticamente significativas. La pérdida total de nitrógeno ureico fue significativamente mayor en los pacientes malnutridos, 13,32 ± 2,92 g/l (p < 0,005). El porcentaje promedio de pérdida de peso en ambos grupos difería significativamente: 0,111 ± 0,044 vs 0,031 ± 0,028, p < 0,0005. En el grupo de pacientes malnutridos, la fuerza media de la mano derecha fue de 26,52 ± 8,06 kg y de la izquierda 25,35 ± 6,04 kg; estos valores fueron significativamente menores que los resultados registrados en los pacientes bien nutridos: 34,93 ± 11,27 kg, 32,37 ± 11,72 kg, p < 0,001. El promedio de tiempo en la prueba de golpear fue de 19,24 ± 4,04 vs 16,72 ± 3,06 para la mano derecha y de 19,69 ± 3,59 kg vs 17,48 ± 2,79 kg para la mano izquierda, siendo significativamente más prolongado en los pacientes con malnutrición (p < 0,01). Los tiempos de reacción simple para la mano dominante fueron más prolongados en el grupo de pacientes con malnutrición, para el estímulo visual 0,50 ± 0,08 s vs 0,45 ± 0,087 s, (p < 0,05) y para el estímulo auditivo 0,43 ± 0,08 vs 0,39 ± 0,08 s (no significativo). 
Conclusiones: la malnutrición en el curso del cáncer de pulmón no microcítico reduce significativamente la función psicomotriz evaluada mediante el tiempo de reacción a estímulos visuales y acústicos así como la eficiencia de las pruebas funcionales mediante la medición de la prueba de golpear y la fuerza muscular (AU)

Videothoracoscopy and muscle flaps in the treatment of bronchial stump fistula.

The aim of the paper is to report our surgical technique applied for treatment of broncho-pleural fistula (BPF) as well as the results of the treatment. From 1992 to 1998 we performed 127 pneumonectomies for lung cancer. In 5 cases (3.9%) bronchial stump insufficiency developed postoperatively. Three patients were treated by means of videothoracoscopy (the Multifire Endo Hernia Stapler was used to clipped the fistula). Rethoracotomy with myoplasty was performed four times in 3 patients. In one patient both the methods were employed. In 2 out of 3 cases videothoracoscopic treatment was successful and the patients were discharged without signs of BPF and pleural empyema. In one case the recurrence of the fistula occurred and the stump of the bronchus was successfully covered with the pectoral musce flap 3 days later. In two cases after rethoracotomy and myoplasty (one of them was reoperated twice) the recurrence of BPF occurred and both the patients died due to cardiopulmonary failure. Despite the limited experience, we think videothoracoscopy is worth considering as a tool for treatment of BPF.

Right ventricular morphology and function after pulmonary resection.

OBJECTIVE: To identify the effect of pulmonary resection on right ventricular performance and its possible contribution to mortality and morbidity. METHODS: Before and 2 days after pulmonary resection for primary lung cancer in 31 patients (21 males; ages 32-69 years), echocardiographic examinations of the right ventricle were performed. Systolic, diastolic and stroke volumes as well as right ventricular ejection fraction were estimated. Right ventricular volumes were calculated using the subtracting method. RESULTS: Right ventricular end-diastolic volume index increased significantly in patients after pneumonectomy: 80.4+/-7.2 ml/m2 versus preoperative evaluation: 66.1+/-5.2 ml/m2 (P = 0.031). In patients who underwent pneumonectomy right ventricular ejection fraction significantly decreased from 48+/-5.0% preoperatively to 39%+/-4.1% after surgery (P = 0.027). Fourteen patients after pneumonectomy had development of supraventricular arrhythmias postoperatively. These patients had much higher right ventricular end-diastolic volume index (76.3+/-6.4/82.1+/-7.4; P = 0.032) and lower right ventricular ejection fraction (42+/-4.3/37+/-3.9; P = 0.021) after surgery in comparison with patients who had normal sinus rhythm postoperatively. CONCLUSION: Pulmonary resection caused a significant dilatation and dysfunction of right ventricle in the early postoperative period. Early detection of deterioration in right ventricular function after pneumonectomy may provide the opportunity for interventional therapy.

Pectus excavatum: increase of right ventricular systolic, diastolic, and stroke volumes after surgical repair.

OBJECTIVE: The study was undertaken to assess how a surgical correction of funnel chest modifies right ventricular structure and function. METHODS: Before and 6 months after surgery in 42 patients (27 male and 15 female patients, aged 5-31 years), a pectus index was calculated and echocardiographic examinations of the right ventricle were performed, with calculation of systolic, diastolic, and stroke volume indices. Right ventricular volume was estimated by subtracting the left ventricular volume from that of the entire heart. The values of the right ventricular volumes and the pectus index before and after the operation, as well as the changes in the indices, were compared. RESULTS: Statistically significant changes in the pectus index and the right ventricular volume indices after surgery were noted. No correlation was observed between the changes in the pectus index and the changes in any right ventricular volume indices. CONCLUSION: Surgical treatment of funnel chest causes an increase in right ventricular systolic, diastolic, and stroke volumes, although there is no correlation between these changes and the degree of sternocostal elevation.

Long-term observation in 68 patients operated on for pectus excavatum: surgical repair of funnel chest.

BACKGROUND: Recurrence after correction of pectus excavatum may sometimes occur, but its origin is not clear. The type of deformity, surgical technique, and patient lifestyle after operation can all affect the final shape of the thorax. The purpose of the present study was to compare the short-, medium-, and long-term cosmetic results of funnel chest repair. METHODS: Sixty-eight patients (mean age, 12.1+/-5.4 years; 48 male) were operated on for pectus excavatum using the same surgical technique: subperichondrial resection of the abnormal costal cartilages and stabilization of the elevated anterior chest wall with Kirschner's wires. The patients were followed up every year (1 to 10 years) after operation, and the anterior chest wall contour was checked by physical examination and x-ray film. RESULTS: Excellent to good cosmetic results 1 year after operation were achieved in 66 patients (97.1%). During the later follow-up period, a mild or moderate degree of recurrent sternal depression was noted in 6 patients (8.8%), teenagers only, 3 to 9 years after primary repair. CONCLUSIONS: Our technique for correction of pectus excavatum yields good short-term cosmetic results. Late recurrence of the deformity occurs during pubertal growth and does not appear to depend on surgical technique or length of follow-up.

Cardiorespiratory function before and after operation for pectus excavatum: medium-term results.

OBJECTIVE: The study was undertaken in order to assess the degree of impairment of the cardiovascular system in patients with funnel chest and to investigate any changes caused by surgical correction. METHODS: Echocardiographic examinations with systolic, diastolic and ejection volume indices calculation as well as pulmonary function tests were performed before surgery and at medium-term follow-up on 34 patients who were operated on for pectus excavatum between 1987 and 1992. RESULTS: The mean age was 13.4 years. There were 70.6% males. Pulmonary function was found to be restricted preoperatively in 18 patients. Inspiratory vital capacity and forced expiratory volume were increased or did not change at follow-up (5 years) in these patients. In cases with normal or moderately restricted pulmonary function (inspiratory vital capacity, forced expiratory volume more than 75% predicted) the reduction of lung function was noted after surgery. Marked haemodynamic improvement was found with the increase of diastolic and ejection volume of both heart ventricles (mainly right one). The improvement was more evident in patients with severe deformations. CONCLUSION: Only in case of severe reduction of lung function in a patient with funnel chest can one expect improvement after surgery. Sternocostal elevation improves function of both heart ventricles at rest.

[The value of endoluminal multiplane ultrasonography in evaluation of rectal cancer progression]. / Wartosc ultrasonografii przezodbytniczej wieloplaszczyznowej w ocenie zaawansowania raka odbytnicy.

The authors present the value of transrectal endosonography in estimating infiltration of each layer of the rectum wall and neighboring organs and metastases into rectal lymphatic glands. The sensitivity of the examination in authors hands was about 83.7%. Authors prove the usefulness of endosonography in the proper assessment of the rectal cancer staging.

[Taking advantage of thoracoscopic techniques for diagnosis and treatment of thoracic diseases]. / Wykorzystanie techniki torakoskopowej w diagnostyce i leczeniu chorób klatki piersiowej.

The authors report their experience in VATS technique employed in the diagnosis and treatment of pleural and mediastinal diseases and lung tumors. Between 1992 and 1996, 50 thoracoscopic procedures were carried out in 48 patients. The following operations were performed: six thoracic sympathectomies, two cases of closing bronchial stump fistulas, six cases of successfully treated spontaneous pneumothorax. In eight cases (16.3%) it was necessary to convert this procedure into thoracotomy because of pleural adhesions. The diagnostic thoracoscopies (35 cases) included: mediastinal and lung tumor biopsies, taking up samples of pleural exudate. There were no complications connected with these procedures. We consider thoracoscopic technique to be a suitable method for the diagnosis and treatment of mediastinal and pleural lesions.

[Gunshot injuries of the thoracic and abdominal cavities in peace time]. / Rany postrzalowe klatki piersiowej i brzucha w czasie pokoju.

Authors present gunshot damage of the chest and abdominal organs. The large number of wounded people particularly young men in the period of 12 years proves to have a widespread problem. They present an important of diagnostic examination, methods of surgical treatment complications and morbidity and mortality in the group of 627 patients.

[Pathophysiologic aspects of extracorporeal shock wave lithotripsy]. / Patofizjologiczne aspekty zólciowej litotrypsji zewnatrzustrojowej.

The function of the gallbladder in 48 patients with cholecystolithiasis who were subjected Extracorporeal Shock Wave Lithotripsy (ESWL) is reported in the paper. The measurements were obtained basing on ultrasonography before and after the treatment. The following parameters were estimated: maximal and minimal gallbladder volume, ejection time, ejection fraction and gallbladder ejection rate. It was concluded, basing on the obtained results, that the initial gallbladder function had no influence on the outcome of the treatment. The function of the gallbladder maintained weakened over the following six weeks after ESWL only in the patients in whom the treatment was unsuccessful.

[A case of complete Th7-Th8 fracture-dislocation treated by one-stage posterior and transthoracic approach]. / Przypadek calkowitego podwichniecia Th7-Th8 bez uszkodzenia rdzenia kregowego operowany z jednoczasowego dojscia tylnego i przez klatke piersiowa.

The authors present a case of severe traumatic fracture-dislocation of Th8 with total anterior slippage of Th7 on Th8 without spinal cord injury. The patient underwent one-stage anterior and posterior decompression. Posterior surgery included Th4 to Th9 laminectomy and Th7-Th8 facetectomy and posterior bone graft. Anterior procedure included Th8 vertebrectomy, anterior interbody bone graft and anterior plating with usage of "Zespol" plate and screws anchored in Th6, Th7, Th8 and Th9 vertebral bodies. Postoperative period was uneventful and the patient remained neurologically intact. He was placed in a plaster jacket and mobilized of fifth day after surgery.