Solitary fibrous tumors of the pleura.

Two cases of female patients with solitary fibrous tumor of the pleura are described. Chest radiography and computed tomography showed the presence of a giant mass with inhomogeneous density in the hemithorax in both cases. Transthoracic needle biopsy of the masses showed benign fibrous tissue. Both patients underwent thoracotomy. The tumors arose from the visceral pleura, were peduncular, appeared well-circumscribed with exterior surface smooth, firm and multinodular. The size of tumors were 16x11x6 cm and 15x11x4.5 cm, weighed 650 g and 573 g and both were successfully resected. The pathological diagnosis was benign solitary fibrous tumor of the pleura. Seven years after the operations the clinical condition and chest radiography are normal in both women.

Light-induced molecular adsorption and reorientation at polyvinylcinnamate-fluorinated/liquid-crystal interface.

We have carried out a detailed experimental study, by means of x-ray reflectometry (XRR) and half-leaky guided mode (HLGM) optical characterization, of the light-induced molecular adsorption and reorientation at the polyvinylcinnamate-fluorinated (PVCN-F)/liquid-crystal (LC) interface of a LC cell doped with the azo-dye methyl red (MR). The XRR data allowed characterizing the microscopic structure of the adsorbed dye layer both before irradiation (dark adsorption) and after irradiation (light-induced adsorption). The HLGM optical characterization has made possible the experimental determination of the nematic director profile in the LC cell and evaluation of the effects of light-induced adsorption on the LC anchoring conditions. The experimental findings have confirmed the formation of a dark-adsorbed layer and are in agreement with the absorption model previously proposed to account for the complex phenomenology related to light-induced anchoring and reorientation in dye-doped liquid crystals.

p53 and c-myc alterations in patients with non-small cell lung carcinoma in Serbia.

PURPOSE: To determine the incidence of c-myc amplification and p53 mutations in patients with stage I, II and III of histologically confirmed non-small cell lung cancer (NSCLC) of different histological subtypes: adenocarcinomas (AC), squamous cell carcinomas (SCC), large cell carcinomas (LCC) and adeno-squamous carcinomas (AC-SCC) and of histological grade (G) 2 and 3. MATERIALS AND METHODS: DNA was isolated from 41 frozen tumor samples by standard phenol-chloroform extraction. Amplification of c-myc gene was determined by the differential polymerase chain reaction (PCR) method, followed by polyacrylamide gel electrophoresis, and mutations in exons 5, 6, 7 and 8 p53 gene were detected by the PCR single-strand conformation polymorphism (SSCP) method. RESULTS: c-myc gene amplification was found in 2 of 41 (4.9%) analyzed tumors and both amplifications were found in stage III tumors. Mutations in the p53 gene were found in 19 of 41 (46.3%) of the analyzed tumors. SCC and LCC were more likely to contain mutations in p53 gene (68.4% and 66.7%, respectively). CONCLUSION: Our results indicate that p53 mutations are common in NSCLC with higher incidence in SCC compared with other histological subtypes. Since the mutations are more frequent in early-stage NSCLC, it appears that mutations in p53 gene could be an early event in lung carcinogenesis. On the other hand, c-myc amplification is a rare event in NSCLC and occurs in the late phase of development of this type of lung cancer.

Survival of patients with resected pIIIa - N2 non small cell lung cancer: suggestion for subclassification.

PURPOSE: The group of completely resected stage IIIa- N2 non small cell lung cancer (NSCLC) patients is considered heterogeneous in various aspects including survival and pattern of recurrence. The prognostic factors still remain controversial. Clinical trials dealing with multimodal strategy for N2 NSCLC are being watched with keen interest, and the feasibility of this strategy is to be confirmed. In the present study we attempted to clarify the role of different clinicopathological factors which separate patients into high and low- risk groups based on the disease-free and overall survival. PATIENTS AND METHODS: The study comprised 60 consecutive patients with pathologically (p) proven N2 NSCLC who had undergone complete surgical disease resection with curative intent between January 1997 and September 2000. All patients had an apparently resectable disease at preoperative staging and thoracotomy. Extensive mediastinal lymph node dissection was performed when possible and consisted of removal of all ipsilateral mediastinal lymph nodes. Patients were submitted to postoperative split course adjuvant radiotherapy. Cumulative survival rates were calculated by the Kaplan-Meier method. The analyzed prog- nostic factors were age, histological type and grade of differentiation, clinical (c) stage, cN status and tumor size and were tested for statistical significance by univariate analysis using log-rank test and Willcoxon test. RESULTS: The median follow-up period was 36 months (range 24-72 months). Tumor size, cN status and age were significant predictors of survival. Large tumor size (T3) was significantly worse predictor compared to T1 (p=0.046) and cN2 status evaluated by computed tomography (CT= also showed statistically significant unfavorable prognosis in comparison with cN0 and cN1 (p=0.0185). Patients over 65 years had significantly worse prognosis compared to those under 65 years (p=0.008). CONCLUSION: This study identified stage IIIa - N2 NSCLC prognostic subgroups and suggests different therapeutic approach according to the subgroup profile.

Structure of self-assembled liposome-DNA-metal complexes.

We have studied the structural and morphological properties of the triple complex dioleoyl phosphatidylcholine (DOPC)-DNA-Mn2+ by means of synchrotron x-ray diffraction and freeze-fracture transmission electron microscopy. This complex is formed in a self-assembled manner when water solutions of neutral lipid, DNA, and metal ions are mixed, which represents a striking example of supramolecular chemistry. The DNA condensation in the complex is promoted by the metal cations that bind the polar heads of the lipid with the negatively charged phosphate groups of DNA. The complex is rather heterogeneous with respect to size and shape and exhibits the lamellar symmetry of the L(c)(alpha) phase: the structure consists of an ordered multilamellar assembly similar to that recently found in cationic liposome-DNA complexes, where the hydrated DNA helices are sandwiched between the liposome bilayers. The experimental results show that, at equilibrium, globules of the triple complex in the L(c)(alpha) phase coexist with globules of multilamellar vesicles of DOPC in the L(alpha) phase, the volume ratio of the two structures being dependent on the molar ratio of the three components DOPC, DNA, and Mn2+. These complexes are of potential interest for applications as synthetically based nonviral carriers of DNA vectors for gene therapy.

X-ray micro-diffraction analysis of reconstructed bone at Zr prosthetic surface with sub-micrometre spatial resolution.

The purpose of the present investigation is to demonstrate the power of the x-ray micro-diffraction technique in biological studies. In particular the reported experiment concerns the study of the interface between a Zr prosthetic device implanted in a rat femur and the newly-formed bone, with a spatial resolution of 0.5 microm. The obtained results give interesting information on the Zr deformation and on the crystallographic phase, the grain size and the orientation of the new bone. Moreover the study reveals a marked difference in the structure of the reconstructed bone with respect to the native bone, which cannot be appreciated with other techniques.

[Papillary carcinoma of the thyroid in intrathoracic goiter]. / Papilarni tireoidni karcinom u intratoraksnoj strumi.

Intrathoracic goiter (more than 80% of tissue in the thoracic cavity) represents very rare clinical entity (less than 1% of total number of thyroid gland surgical procedures). Cancer incidence in these goiter is 0-5%. The aim of this article is to present a case report of intrathoracic thyroid papillary carcinoma with multiple compressive syndrome and review of compressive intrathoracic syndrome of thyroid etiology. In our patient we have found: tracheal and oesophageal deviation and compression, superior vena cava syndrome, downhill varices, chylothorax, pericardial effusion, compress of the left a. subclavia, unilateral lesion of recurrent and phrenic nerve, and brachial plexopathy. This was a unique case with multiple compressive syndrome between 3000 patients surgically treated for all kinds of thyroid diseases. Intrathoracic goiter can cause all the known symptoms and syndromes of intrathoracic compression with possibility of rapid deterioration and fatal end.

Osteointegration of bioactive glass-coated zirconia in healthy bone: an in vivo evaluation.

Osteointegration of yttria stabilised tetragonal zirconia (YSTZ), either coated with bioactive glass named RKKP bioglaze (RKKP) or uncoated, was evaluated in an animal model. RKKP-coated and uncoated (controls) YSTZ cylinders were implanted in the distal femoral epiphyses of 14 Sprague Dawley rats under general anaesthesia. At the experimental times of 30 and 60 days after sacrifice, histomorphometry and SEM microanalysis were performed on methylmethacrylate-embedded undecalcified sections to determine the osteointegration rate. At 30 days, a significantly higher affinity index was demonstrated in vivo by histomorphometric evaluation in RKKP-coated versus uncoated YSTZ implants p < 0.05); at 60 days, the coated implants behaved better than controls (affinity index of + 32%), but the difference observed lay within the statistical uncertainty. SEM analysis demonstrated better bone adhesion to the material in RKKP-coated YSTZ at both 30 and 60 days. These findings suggest that YSTZ coated with the bioactive glass named RKKP enhances osteointegration of ceramics.

Improvement in zirconia osseointegration by means of a biological glass coating: An in vitro and in vivo investigation.

The biocompatibility and osseointegration of zirconia (ZrO(2)), either coated with RKKP bioglazeor uncoated, were evaluated in vitro and in vivo. The in vitro test was performed in human osteoblasts, whereas maximal sensitization was performed in 23 Dunkin Hurtley guinea pigs. RKKP bioglaze-coated and uncoated (controls) ZrO(2) cylinders were implanted in the distal femoral epiphyses of 14 Sprague-Dawley rats under general anesthesia, and animals were sacrificed at 30 and 60 days. Lactate dehydrogenase, alkaline phosphatase, and Thiazolyl Blue (MTT) were tested in vitro. A graded score was used for evaluating the results of the sensitization test. Histomorphometry and microhardness testing were performed to quantify the osseointegration rate, as well as bone quality around the implants. Neither in vitro cytotoxicity nor sensitization were observed. Histomorphometry demonstrated that at 30 days, the affinity index was significantly higher in coated implants than in uncoated ones (p < 0.05); at 60 days, the behavior of coated implants was better than that of uncoated ones, but differences were not significant. Significant increases in bone microhardness were found at 1000 microm from the interface area for both uncoated (p < 0.0005) and RKKP bioglaze-coated (p < 0.0005) ZrO(2), and also within 200 microm from the interface (p = 0.014) but only for coated ZrO(2.) These results suggest that RKKP bioglaze-coated ZrO(2) permits biocompatible devices with improved osseointegration properties to be manufactured.

Intrathoracic goiter: analysis of 21 cases.

UNLABELLED: Goiters are classified into: the cervical, retrosternal, substernal and intrathoracic. The aim of research is to analysis of intrathoracic goiters (ITG) which include goiters with more than 80% of tissue in the thoracic cavity and intrathoracic thyroid choristomas. METHODS: In prospective non-randomized study were analyzed 21 consecutive patients operated on for intrathoracic non-toxic benign goiters from 1987-98. Fourteen patients with intrathoracic goiters (more than 80% of tissue in the thoracic cavity) and seven patients with intratoracic choristomas were operated. Two groups of ITG were observed according to the expressed symptomatology and surgical approach and complications of operative treatment were compared to the complications of operative treatment of 986 non-ITG non-toxic benign goiters. RESULTS: ITG represented 1.1% of the whole number of operatively treated thyroid diseases. One third of patients were asymptomatic. Commonly observed symptoms were dispnea, stridor and dysphagia and there was no significant difference in appearance of these symptoms between the two groups of ITG. In 19% of patients correct preoperative diagnosis wasn't assessed. Cervical approach with sternothomy was used in 11 patients, cervical approach with right thoracotomy in seven, right thoracotomy only in two, and cervical approach only in one patient. Thoracic approach was used in 95% of cases and there was no significant difference between the two groups of ITG. Concerning the operative complications, in two patients transient vocal cord paresis and in one patient postoperative bleeding were verified. There was no statistically significant deference in frequency of operative complications between ITG and non-ITG. CONCLUSIONS: ITG are rare, but might present a difficult diagnostic and complex surgical problem. Common clinical presentation and identical surgical approach in operative treatment justify the common review of the two groups of intrathoracic goiters. With adequate and timely performed surgical approach, in specialized institutions, frequency of complications in operative treatment of ITG is not higher if compared to operative treatment of non-ITG.

[Surgical treatment of rare anatomic variations and anomalies of the thyroid gland]. / Hirursko lecenje retkih anatomskih varijacija i anomalija stitaste zlezde.

Choristoma and thyroid gland malpositions are embryonal disorders. The aim of this article is ten years analysis of their diagnostic and operative treatment. In 1425 thyroidectomies we have found: one lingual, intratracheal, intracardial thyroid and ovarial struma; six separated intrathoracic goitre and 10 mostly intrathoracaly (80%) situated goitre; 1.4% out of all. Correct preoperative diagnosis we have in lingual thyroid, two intrathoracal thyroid and in all mostly intrathoracal thyroids, and in others after histopathological examination. Operative approach was: collar incision with medial sternotomy in nine, collar incision with lateral thoracotomy in three, right thoracotomy in two, and only collar incision in one. There were two operative complications, one recurrent nerve lesion and one mediastinal haematoma. There was no hypocalcaemia and mortality. Thyroid gland anomalies are very rare and associated with lot of problems in diagnostic and treatment. In specialised institutions frequency of operative complications is the same like in routine thyroid gland surgery.

[Traumatic rupture of the left hemidiaphragm]. / Traumatska ruptura leve hemidijafragme.

A case of blunt traumatic rupture of the left hemidiaphragm following a traffic accident was presented. On admission the patient complained of a dyspnoea, and the physical examination of the thorax revealed the absence of breathing sound on the left side. A chest radiography and CT scan had shown the presence of the stomach in the left hemithorax. Posterolateral thoracotomy was performed. In the opened hemithorax, the stomach, omentum and small bowel were found to having passed undamaged through a 12 cm tear of the central part of the diaphragm. These abdominal viscera were replaced in the abdomen and the diaphragm was sutured.

[Resection of post-intubation tracheal stenosis]. / Resekcija postintubacijskestenoze vratnog dela traheje.

The management of a patient with post-intubation circumferential stenosis and tracheostomy was presented. Tracheal resection and reconstruction were performed. The length of resection was four centimeters. The tracheostomy was included in the resected part. The problems of tracheal dissection and mobilization and approximation of the tracheal ends due to the anastomosis were presented. The possibilities of the intubation and adequate ventilation across the operative field were shown.

[Multiple intrathoracic compression syndrome of thyroid etiology]. / Visestruki intratoraksni kompresioni sindrom tireoidne etiologije.

The aim of this article is to present a case report of multiple compression syndrome caused by intrathoracic thyroid papillary carcinoma and the review of compression intrathoracic syndrome of thyroid etiology. In our patient were confirmed: tracheal and esophageal deviation and compression, superior vena cava syndrome, downhill varices, chylothorax, pericardial effusion, compression of the left subclavian artery, unilateral lesion of recurrent and phrenic nerve, and brachial plexopathy. This was a unique case with multiple compression syndrome out of 2000 patients surgically treated for all kinds of thyroid diseases. Intrathoracic goiter can cause all the known symptoms and syndromes of intrathoracic compression with a possibility of rapid deterioration and fatal outcome.

[Staphylococcal pneumonia associated with pneumatoceles, bilateral pyopneumothorax and sepsis]. / Stafilokokna pneumonija pracenja pneumatocelama, obostranim piopneumotoraksom i sepsom.

A case of soldier with community acquired staphylococcal pneumonia and multiple pneumatoceles as the rare complication in adults is presented. Their recognition provides appropriate treatment. In the patient were developed bilateral pneumothorax, pleural empyema and sepsis. Surgical treatment was performed by thoracic drainage. Recovery of pulmonary function was poor, as distinguished from children.

The advantages of limited resection vs. suture in the primary management of penetrating lung war wounds.

The aim of this study was to prove the advantage of the limited lung resection vs. suture in the primary management of penetrating lung war wounds. A prospective clinical study was presented about the results of primary surgical treatment of 50 injured with penetrating lung wounds, operated at the Military Medical Academy. The patients were divided into two groups: primary group was comprised of the wounded with limited resection, and the control group of the wounded with lung suture. Among the observed parameters, special attention had been paid to the specific postoperative complications, observed in 48% of the wounded from the group with lung suture (p < 0.01). The results of the investigation have demonstrated the significant advantage of limited resection vs. suture, and the method itself revealed all the features of radical and definite management of severe lung injuries. Precise indications for the use of both treatment methods are given.

[Hemangiopericytoma of the lungs]. / Hemangiopericitom pluca.

Six patients, three women and 3 men with lung hemangiopericytoma treated at the Military Medical Academy in the period 1971-1991 are reported. The youngest patient was 20 years, the oldest 69 years. Surgical treatment was performed in all patients, 3 lobectomies, one bilobectomy, one wedge resection and one extirpation. Multiple hemangiopericytoma was found in one patient which consisted of three separate tumours in the right lung. The other had solitary lesions. Malignant hemangiopericytoma, was found in 4 patients, one of them had metastases in the mediastinal lymphatic glands. Four patients are alive and are under control for nine years in the average without signs of recurrence.

[Decortication of the lung in the treatment of nonspecific pleural empyema]. / Dekortikacija pluca u lecenju nespecificnih empijema pleure.

In the period 1986-1990 at the Clinic of Cardiac and Thoracic Surgery 86 patients with nonspecific pleural empyema were treated. There were 18 men and one woman, mean age of 35.6 years. Causes of empyema have been the following: pleuropneumonia (10 patients), chest trauma (2), iatrogenic pleural infection (2), spontaneous pneumothorax (2), mediastinitis (1) and pleural infection per continuitatem (2). The authors consider that decortication should be performed as early as possible, immediately after stabilization of acute signs of infection. The optimal time for surgery is from to six hours since the onset of the disease.