Unilateral lumbar fusion.

Unilateral fusion of the lumbar spine is rarely necessary or indicated. However, in patients with a "far-out syndrome" requiring decompression or in cases where unilateral posterior element resection is necessary for any reason, it may be both necessary and indicated. This unilateral destabilization effectively removes one leg of the tripod, rendering that intervertebral joint potentially unstable. The charts and radiographs of 13 patients (seven men, six women) with an average age of 60 years (range, 25 to 76) who underwent unilateral fusion were retrospectively reviewed. Follow-up time ranged from 12 1/2 to 2 years with a median follow-up of 8 years. Eleven of the fusions were at one level, and two were at two levels. Seven patients had a far-out syndrome secondary to degenerative scoliosis; four were secondary to spondylolisthesis. Two patients had an osteoid osteoma involving a pedicle. A paraspinal approach was used in the majority of patients. Autologous bone graft was used in all patients. Unilateral pedicle screw fixation was used in the last patient in the series. The fusion rate was 85% (11/13). Three patients were smokers, two of whom developed pseudarthrosis. Disc space height did not appear to affect fusion rate. There was no progression of slip noted in any of the patients. One complication was noted in this group: a moderate postoperative infection, which cleared spontaneously.

Scintigraphy with gallium-67 citrate in staging of soft-tissue sarcomas of the extremity.

We performed a retrospective study of sixty patients who had a soft-tissue sarcoma of the extremity to determine the usefulness of scintigraphy with gallium-67 citrate as a staging modality. Abnormal activity of the gallium was present in forty-one of forty-eight sites in which there was macroscopic primary tumor. In six of the forty-eight patients, the imaging demonstrated non-pulmonary metastases that had not been detected by any other staging studies. Scintigraphy with gallium-67 citrate should be employed routinely for staging of soft-tissue sarcomas because of its utility in detecting non-pulmonary metastases that are not otherwise detected on routine staging studies.

The use of serum albumin for further classification of Stage III non-oat cell lung cancer and its therapeutic implications.

The use of the preadmission serum albumin level for predicting survival was evaluated in 81 patients with Stage III disease, 59 with unresectable and 22 with resectable primary tumors. A serum albumin of less than 3.4 gm/dl in a patient with unresectable Stage III disease indicates a poor prognosis with an accuracy that supersedes that obtained from a clinical assessment of the anatomical extent of disease. Seventeen of the 22 patients with resectable Stage III disease had a preadmission level of albumin of 3.4 gm/dl or greater. The median survival was 20.5 months, which was statistically longer than 9.9 months for 12 patients with unresectable Stage III M0 disease and an albumin level of 3.4 gm/dl or greater (p less than 0.05). Five of the 22 patients who underwent resection had a preadmission albumin level of less than 3.4 gm/dl. The median survival for these patients was 9.7 months compared with 20.5 months for those with a level of 3.4 gm/dl or greater. These findings suggest that resection of Stage III disease in patients with an albumin level of 3.4 gm/dl or greater prolongs survival. Another group of 5 patients with resectable Stage III disease and an albumin level of less than 3.4 gm/dl were force-fed an elemental diet while undergoing a regimen of preoperative radiation therapy. There was no improvement in survival, and 3 died of the disease prior to resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchogenic carcinoma located in the aortic window. The importance of the primary lesion as a determinant of survival.

Thirty-four patients with an aortic window lesion were carefully staged with gallium scans and mediastinoscopy according to the TNM classification system for carcinoma of the lung. All were in Stage III. Twenty-five patients had non-oat cell carcinomas (15 squamous cell, eight adeno-, two large cell) and nine had oat cell carcinomas. Quantitative ventilation-perfusion lung scans were particularly helpful in verifying the subaortic location of the tumor by showing a less than 20% interference with pulmonary blood flow or ventilation secondary to left mainstem bronchus or pulmonary artery invasion. Decision for resectability in 13 Stage III M0 patients was based on the length of the uninvolved proximal left main pulmonary artery seen on pulmonary arteriogram. Eight patients (seven non-oat cell and one oat cell) had resection after radiation and prior to chemotherapy (after two cycles of chemotherapy and prior to radiation therapy for the oat cell) with a resultant survival rate better than those of M0 and M1 non-oat cell or oat cell patients without resection. The survival rates of nine non-oat cell M0 patients, nine non-oat cell M1 patients, and eight oat cell patients, all without resection, were not statistically different. This similarity in survival rates is explained by the observation that 38% of the non-oat cell M1, 71% of the non-oat cell M0, and 63% of the oat cell patients died from complications of their primary tumor. Patients with aortic window lesions, irrespective of their histology, have an extremely poor prognosis due to the high incidence of lethal complications of their primary tumor. Complete resection when feasible, as judged by pulmonary arteriography, provides the best control of the primary tumor and, as a consequence, gives longer survival.