Atypical carcinoid tumours of the lung: prognostic factors and patterns of recurrence.

BACKGROUND: Atypical carcinoids (AC) of the lung are rare intermediate-grade neuroendocrine neoplasms. Prognostic factors for these tumours are undefined. METHODS: Our cooperative group retrieved data on 127 patients operated between 1980 and 2009 because of an AC. Several clinical and pathological features were studied. RESULTS: In a univariable analysis, T-status (p=0.005), N-status (p=0.021), preoperative M-status (previously treated) (p=0.04), and distant recurrence developed during the outcome (p<0.001) presented statistically significant differences related to survival of these patients. In a multivariable analysis, only distant recurrence was demonstrated to be an independent risk factor for survival (p<0.001; HR: 13.1). During the monitoring, 25.2% of the patients presented some kind of recurrence. When we studied recurrence factors in a univariable manner, sublobar resections presented significant relationship with locoregional recurrence (p<0.001). In the case of distant recurrence, T and N status presented significant differences. Patients with preoperative M1 status presented higher frequencies of locoregional and distant recurrence (p=0.004 and p<0.001, respectively). In a multivariable analysis, sublobar resection was an independent prognostic factor to predict locoregional recurrence (p=0.002; HR: 18.1). CONCLUSIONS: Complete standard surgical resection with radical lymphadenectomy is essential for AC. Sublobar resections are related to locoregional recurrence, so they should be avoided except for carefully selected patients. Nodal status is an important prognostic factor to predict survival and recurrence. Distant recurrence is related to poor outcome.

Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years.

INTRODUCTION: Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society) and ERS (European Respiratory Society) for Idiopathic Pulmonary Fibrosis (IPF). PATIENTS AND METHODS: We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002) and group 2 (operated between 2003 and 2011). Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed. RESULTS: Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84%) deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70%) of 10 cases, alveolar haemorrhage in 2 (20%) and heart failure in 1 (10%). CONCLUSIONS: Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality.

Cross-industry standard process for data mining is applicable to the lung cancer surgery domain, improving decision making as well as knowledge and quality management

OBJECTIVES: The aim of this study was to assess the applicability of knowledge discovery in database methodology, based upon data mining techniques, to the investigation of lung cancer surgery. METHODS: According to CRISP 1.0 methodology, a data mining (DM) project was developed on a data warehouse containing records for 501 patients operated on for lung cancer with curative intention. The modelling technique was logistic regression. RESULTS: The finally selected model presented the following values: sensitivity 9.68%, specificity 100%, global precision 94.02%, positive predictive value 100% and negative predictive value 93.98% for a cut-off point set at 0.5. A receiver operating characteristic (ROC) curve was constructed. The area under the curve (CI 95%) was 0.817 (0.740- 0.893) (p < 0.05). Statistical association with perioperative mortality was found for the following variables [odds ratio (CI 95%)]: age over 70 [2.3822 (1.0338-5.4891)], heart disease [2.4875 (1.0089-6.1334)], peripheral arterial disease [5.7705 (1.9296-17.2570)], pneumonectomy [3.6199 (1.4939-8.7715)] and length of surgery (min) [1.0067 (1.0008-1.0126)]. CONCLUSIONS: The CRISP-DM process model is very suitable for lung cancer surgery analysis, improving decision making as well as knowledge and quality management (AU)

Pulmonar collision tumor: metastatic adenoid cystic carcinoma and lung adenocarcinoma.

We report an extraordinary case of collision tumor consisting of a lung adenocarcinoma and a metastatic adenoid cystic carcinoma in a 56 year-old man. He was diagnosed with a pulmonary nodule 11 years after treatment of an adenoid cystic carcinoma of the right maxillary sinus. A non-small cell carcinoma was observed when a transbronchial biopsy was performed. The other component of the nodule was only diagnosed with pathological examination of the resection specimen.

Bronchogenic carcinoma in patients under 50 years old.

INTRODUCTION: Lung cancer in young patients is increasing in frequency. Its clinical course seems to be more aggressive than in the elderly. Our objective is to assess the clinicopathologic characteristics and survival of patients with bronchogenic carcinoma who underwent surgery at our department, comparing people younger than 50 years to older patients. MATERIALS AND METHODS: We present a retrospective study of 610 patients diagnosed with non-small-cell lung cancer operated on between 1997 and 2006. They were classified into two groups: under 50 (n=60) and equal to or over 50 (n=550). RESULTS: The proportion of women, smokers and adenocarcinoma were significantly higher in young patients. There were no significant differences in survival rate between the two groups. CONCLUSIONS: In our series, despite the differences in sex, smoking history and histology, the behaviour of the disease is similar in both age groups.

Tumor de Askin de la pared torácica con metástasis precoz / Askin's tumor of the chest wall with early metastasis

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[Cytomegalovirus sensitivity to anti-retroviral agents in patients infected with the human immunodeficiency virus with chorioretinitis in Spain]. / Sensibilidad del citomegalovirus frente a fármacos antivíricos en pacientes infectados por el virus de la inmunodeficiencia humana con coriorretinitis en España.

OBJECTIVES: To determine the prevalence of the in vitro resistance rate of cytomegalovirus (CMV) to gancyclovir (GCV) and foscarnet (FOS) among patients with AIDS and chorioretinitis. Furthermore, in vitro sensitivity results were compared with the clinical response to therapy. PATIENTS AND METHODS: Thirty-six patients with the diagnosis of CMV retinitis and AIDS were included in the study. Antiviral sensitivity testing was performed to 51 clinical CMV strains from these patients. The in vitro sensitivity was compared with the clinical response to therapy. The resistance criteria were the inhibitory dose50 (ID50) GCV > 5 M and ID50 FOS > 400 M. RESULTS: None of the CMV tested strains was resistant to GCV or FOS; however, six patients who had relapses of chorioretinitis while on maintenance therapy and isolation during the condition had mean ID50 of strains (n=8) of 1,95 M for GCV (standard deviation [SD] of 0.71) and 115.2 for FOS (SD, 34.7). These patients responded well when drugs were used at induction doses. CONCLUSION: The in vitro sensitivity testing is not a good predictor of infection control when the drug is used at maintenance doses. This suggests that these strains should be classified in the intermediate resistant category.

[Hyoid fracture and traumatic subcutaneous cervical emphysema from an attempted hanging. Apropos a case]. / Fractura de hioides y enfisema cervical subcutáneo traumático por intento de ahorcamineto. A propósito de un caso.

We describe a patient with a history of psychiatric disorder who was brought to our hospital after attempted suicide by hanging. Severe subcutaneous facial, palpebral and cervical emphysema was present, with dysphonia, dysphagia and slight respiratory difficulty. Fiberoptic bronchoscopy revealed upper airway obstruction due to edema in an intact airway. Successive CAT scans gave evidence of hyoid fracture and laryngocele, in addition to the corresponding emphysema of the subcutaneous area and pneumomediastinum. Given the persistence of dysphagia, we ordered esophageal tests, which showed functional alteration of the upper esophageal sphincter. Suprasternal cervicotomy to drain the pneumomediastinum and laryngeal microsurgery to treat the laryngocele resolved the problem.

[Pneumothorax as the clinical presentation of bronchogenic carcinoma. A report of 3 cases]. / Neumotórax como presentación clínica de un carcinoma broncogénico. Aportación de tres casos.

The association of pneumothorax and lung cancer is rare and diagnosis is complex in such cases. Clinical suspicion of cancer must be based on radiological findings and the existence of risk factors. We discuss the mechanisms involved in the development of pneumothorax in patients with lung cancer, the clinical significance of the association, and the recommended diagnostic approach and therapeutic guidelines.

Fractura de hioides y enfisema cervical subcutáneo traumático por intento de ahorcamiento. a propósito de un caso / Hyoid bone fracture and subcutaneous emphysema due to trauma from attempted hanging: a case report

Presentamos el caso de un paciente con antecedentes psiquiátricos que, tras un intento de autólisis mediante ahorcamiento, fue remitido a nuestro centro. Se apreciaba un gran enfisema subcutáneo facial, palpebral y cervical, con disfonía, disfagia y discreta dificultad respiratoria. La fibrobroncoscopia demostró obstrucción de las vías altas por edema, con integridad de la vía aérea. Varias TAC cervicales sucesivas evidenciaron, además del enfisema subcutáneo y el neumomediastino correspondiente, la existencia de una fractura de hioides, así como la existencia de un laringocele. Ante la persistencia de la disfagia, se realizaron pruebas de función esofágica, demostrándose una alteración funcional del esfínter esofágico superior. Una cervicotomía suprasternal, para el drenaje del neumomediastino, y una microcirugía laríngea, para el tratamiento el laringocele, solucionaron el problema (AU)

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Neumotórax como presentación clínica de un carcinoma broncogénico. Aportación de tres casos / Pneumothorax as the presenting symptom in lung cancer. Three cases

La asociación de un neumotórax y un carcinoma broncopulmonar es muy infrecuente. El diagnóstico es complicado. La sospecha clínica debe establecerse a partir de los hallazgos radiográficos y la existencia de factores de riesgo. Se discuten los mecanismos implicados en la génesis del neumotórax en enfermos con neoplasias malignas del pulmón, así como la significación clínica que tal asociación tiene y, por consiguiente, la actitud diagnóstica y terapéutica recomendada en tales casos. (AU)

[Thymoma. A retrospective study]. / Timomas. Estudio retrospectivo.

We review cases of thymic cell tumor treated between January 1991 and March 1998. Nineteen of the 23 cases studied involved thymoma. Eight (42%) were asymptomatic, 4 (21%) were associated with myasthenia gravis and 7 (37%) were symptomatic. The most common symptom was non-specific chest pain, reported by 4 (47%) patients with symptoms. Classifying the cases of thymoma by Masaoka's system, we found that 12 were cases of thymoma in stage I (63.2%), 4 in stage II (21.1%) and 3 in stage III (15.8%). No stage IV patients were treated. Treatment consisted of full exeresis of the tumor in 17 (89.5%) cases, partial resection in one case (5.2%) and biopsy of the tumor in one non-resectable, case. Adjuvant radiotherapy was applied in seven cases. Chemotherapy was not prescribed. With follow-up ranging from 9 to 96 months, half the patients survived 21 months after surgery. Among the surviving patients, mortality was nil at the end of the study. The results of microscopic, cytologic and blood analyses were of scarce value in differentiating between benign and malignant tumors, even though p53 and bcl2 antigen positivity and clinical stage have been related to poor prognosis in recent years.

Scaphoid fractures and nonunions: a comparison between panoramic radiography and plain X-rays.

This study describes the diagnostic potential of the panoramic X-ray technique in the evaluation of scaphoid fractures and nonunions. Fifty-eight symptomatic wrists were examined using both plain X-rays and the panoramic procedure. The panoramic images showed in detail the line of the scaphoid fracture and nonunion in detail; they revealed four scaphoid fractures and five nonunions that were not shown clearly with plain X-rays. The panoramic technique is a useful complement to plain X-rays for the investigation of scaphoid fractures and nonunions.

Orthopantography of the wrist and the knee.

Initial experience with panoramic radiography of the wrist and the knee is presented. The technique offers potential new evaluation of these joints. A standard PA projection demonstrates the carpal bones with almost no superimposition. Additional projections permit more detailed demonstration of the scaphoid and wrist compartments. Similar panoramic studies of the normal knee demonstrated alternative images of the patella, the femoral condyles and tibial plateau. Orthopantography of the joints may provide additional information in the diagnosis of joints abnormalities.