[Incindentally detected Castleman disease in a patient with allergic rhinosinusitis].

INTRODUCTION: Castleman disease was for the first time described in 1956 as a mediastinal tumour mass. Etiology of this disease is still unknown. The disease can be solitary and multicentric or rarely of a mixed type. The former is often of hyaline vascular type, while the latter is of plasma cell type. CASE REPORT: Castleman disease was diagnosed in a 26-year old male patient when a well defined shadow was incidentally detected in the middle lobe of the right lung. A year before, he was diagnosed with allergic rhinitis to Ambrosia. Two years after surgery the patient was feeling well, and was without any recurrence, however, allergic rhinitis still persisted. CONCLUSION: Castleman disease can occur in any organ containing lymph tissues. Most frequently the disease is described as mediastinal, rarely as an intrapulmonary tumorous mass, and it is most frequently seen in younger persons. The solitary type of Castleman disease is surgical treatable with a prospect of good prognosis, while the multicentric and mixed types recur despite treatment with cortisone, irradiation and cytostatics. As the association between Castleman disease and allergic diseases has not been confirmed up-to-now, it could be concluded that this patient suffered from two separated diseases.

Influence of chronic obstructive pulmonary disease on postoperative lung function and complications in patients undergoing operations for primary non-small cell lung cancer.

OBJECTIVES: Recent data have suggested that there is a flexibility of borderline values of lung function tests in allowing safe lung resection. The aim of this study was to assess the pattern of postoperative lung function change in patients with chronic obstructive pulmonary disease compared with that of patients with normal lung function, and to compare the operative morbidity and mortality between these groups. METHODS: The study included 35 patients with chronic obstructive pulmonary disease and a control group of 47 patients with normal lung function who underwent lung resection for non-small cell lung cancer. The percent changes of lung function parameters after lung resection and operative morbidity and mortality were compared between groups. RESULTS: The mean postoperative loss in forced expiratory volume in the 1st second was significantly less in patients with chronic obstructive pulmonary disease who underwent lobectomy compared with that of patients with normal lung function (11.88% vs 24.6%, P < .05); forced expiratory flows at low lung volumes (50% and 25%) improved in patients who underwent lobectomy. The lung function change after pneumonectomy followed the same trend as that after lobectomy. In patients with chronic obstructive pulmonary disease, forced expiratory volume in the 1st second and small airways function significantly improved after preoperative bronchodilator therapy. In the group with chronic obstructive pulmonary disease, operative mortality was 0 and operative morbidity was 51.43%. CONCLUSIONS: Because the pattern of lung function change is different in patients with chronic obstructive pulmonary disease compared with that of patients with normal lung function, surgery can be offered to carefully selected patients with lung cancer, even in the presence of severely limited lung function.

[Surgical treatment of patients with lung cancer and limited lung function--preoperative assessment, operative mortality and morbidity].

INTRODUCTION: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. OBJECTIVE: The aim of the study was to analyse the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. METHOD: The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analysed depending on preoperative radiographic and bronchoscopic aspect. STATISTICS: chi-square test, t-test. RESULTS: In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1) between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC) in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairement, operative mortality was 3.1%. In the analysed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analysed and control groups occurred in 14.7% and 6.1% of patients respectively (p > 0.05). CONCLUSION: Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and additional lung function assessment.