Pulmonary dissemination of breast cancer is frequent in those patients who have died of the disease and in those survivors who have not been cured after removal of the breast and X-ray treatment in the advanced states of the disease. When the metastases are identified, they are almost always multiple and bilateral. The appearance of a solitary, late pulmonary coin lesion (metachrone) in someone with breast cancer certainly suggests a pulmonary metastasis, but in fact, it is more likely to be a second cancer than a metastasis, that is, a primary bronchopulmonary cancer. The presence of a solitary pulmonary coin lesion in someone who has or who has had breast cancer, presents therefore certain particular problems. After having controlled by xerotomography or CAT that there is no pulmonary diffusion in either lung, that there is no invasion of other tissues or organs, and after having controlled locally around the breast cancer, then it is imperative to remove the lesion without delay since it is certainly malignant and most probably a second cancer, that is a primary broncho-pulmonary cancer, an adenocarcinoma, detected at an asymptomatic stage. the prognosis of a broncho-pulmonary adenocarcinoma, depends on the precocity of its removal.

Adenocarcinoma↗

PubMedDate not supplied

[Pseudo-obstruction and colonic ischemia].

We report the case of a 78 year old male schizophrenic with pseudo-obstruction of the colon complicated by patent-vessel ischaemia that was diagnosed after sub-total colectomy. Surgery was motivated by the chance discovery of a pneumo-peritoneum without peritonitis and without any evidence of perforation in the gastro-intestinal tract. We believe that early surgery is required in patients with pseudo-obstruction of the colon, to prevent complications such as ischaemia of the distended bowel wall which, though rare, is also well recognised.

Aged↗

PubMedDate not supplied

Ischemic diseases of the large intestine.

The blood flow within the walls of the digestive tract must be sufficient to maintain its structural and functional integrity. All episodes of vascular insufficiency cause ischemic damage to the organ and carry the threat of diffuse or focal necrosis. Certain forms of ischemic colitis or proctitis arise from episodes of reduced peripheric or splanchnic blood flow; indeed, those which do not culminate in necrosis of the colonic wall are more frequently caused by hemodynamic disorders than by vascular occlusions. The crisis is often mitigated by the development of collateral circulation; this is, however, of rather poor quality so patients become very vulnerable to subsequent slight changes in cardiac output. Necrotic, gangrenous ischemic colitis arises from a combination of occlusive damage to the arteries and general hemodynamic disturbances. The vascular insufficiency may be slight or severe, temporary or long-lasting, localized or diffuse. In addition, the attack occurs in a septic medium in the presence of abundant microbial flora which may be highly pathologic. Thus infection complicates and aggravates the ischemic damage, resulting in the gangrenous aspect of the lesion tending to hide its ischemic origin. Indeed, the variability of the manifestations of the disease in one of its primary characteristics, and is a function of the different causative factors. A knowledge of the anatomy and pathophysiology of the splanchnic circulation and its hemodynamics is essential for a full appreciation of the diagnosis and treatment of the disorders, and for the adoption of the aggressive approach necessary to improve the poor prognosis of ischemic diseases of the colon and rectum. All treatment should be based on 1) constant, prolonged intensive care; 2) precise monitoring of any change in status; 3) rapid excision of any necrotic (often gangrenous) tissue. Ischemic colitis is most likely to occur in elderly patients with a history of cardiovascular disease, but can also affect younger individuals. It is a frequent, potentially lethal, entity. Although it can be classified as a separate disease on the basis of its clinical, radiological and anatomical characteristics, it is often confused with other disorders of the colon. Although the abdominal surgeon is most likely to be concerned with this disease, the vascular surgeon incising the lower aorta should always be on the look-out for segmentary ischemia of the distal colon which may occur following operation.

Aged↗