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Biomedical subjects

P Goldstraw

Publications and source records attributed to P Goldstraw.

At least 163 records · Page 9Linked to original sources
PubMed1986

Malignant fibrous histiocytoma in thoracic surgical practice.

Malignant fibrous histiocytoma is a rare, although increasingly recognized, deep-seated pleomorphic sarcoma. A primitive tumor, it arises from tissue histiocytes and typically occurs in the extremities. Primary intrathoracic tumors have been reported rarely. The presentation of malignant fibrous histiocytoma in our series of seven patients has been varied. Two cases presented as solitary primary intrapulmonary tumors, two as primary chest wall tumors, one as an anterior mediastinal mass, one as a retroperitoneal tumor extending cephalad through the diaphragm, and one as a late metastasis from a primary pelvic site. Malignant fibrous histiocytoma is aggressive, with a propensity for early local and distant spread; three of the patients in our series died of progressive disease within 17 months of operation. The histologic nature of the tumor makes diagnosis on small biopsy specimens difficult and frequently misleading. We would suggest a policy of open biopsy to obtain adequate and representative specimens for histologic study and preoperative computed tomographic scanning to augment the clinical search for metastatic disease and to facilitate planning of subsequent radical, excisional operation. The preoperative use of deep x-ray therapy or the newer chemotherapeutic agents may reduce tumor bulk and thereby facilitate radical operation, which presently appears to be the most appropriate primary modality of treatment of malignant fibrous histiocytoma.

Adult↗
PubMed1986

Intracardiac metastases from malignant teratoma of the testis.

Cisplatin-based chemotherapeutic regimens are highly successful at controlling testicular teratomas, returning tumor markers to normal in 76% of patients. However, bulky residual disease persists in 24%, and surgical excision of these deposits is becoming increasingly common. This approach is justified, because the histologic characteristics of such deposits gives valuable prognostic information, allowing a decision to be made regarding additional therapy, and relapse of apparently stable disease may occur. Excision of residual bulky disease may be achieved safely. We have recently successfully excised an intracardiac metastasis in a patient with no demonstrable extrathoracic disease and normal serum marker levels.

Adult↗
PubMed1985

Intramural rupture and intramural haematoma of the oesophagus.

We report on two cases of spontaneous intramural rupture and haematoma formation in the oesophagus. This is an unusual and often misdiagnosed condition. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the oesophagus and should be avoided. Treatment is conservative and results in resolution of the haematoma and a return to normal swallowing.

Aged↗
PubMed1985

Open lung biopsy in patients with diffuse pulmonary shadowing.

The radiological appearances of diffuse pulmonary shadowing are not specific and frequently histological examination is necessary to provide a diagnosis or assess the activity of the disease. From July 1979 to May 1983 open lung biopsy was performed in 101 patients through a limited submammary incision. Twenty seven patients had undergone prior invasive investigations and 27 were taking corticosteroids at the time of biopsy. In 92 patients the histological appearances after open lung biopsy were sufficiently specific to permit diagnosis. Respiratory tract infection occurred in six patients and in eight there was some superficial infection of the wound. These complications were more frequent in patients taking corticosteroids but the difference was not statistically significant. The chest drain was removed usually on the first postoperative day. In three critically ill patients an air leak occurred after removal of the drain, requiring formal surgical re-exploration and drainage in two cases and a brief period of intercostal drainage in the third. Four patients in the series died. All had severe pre-existing lung disease; in three open lung biopsy was performed in the late stages of severe, rapidly progressive lung disease eluding diagnosis; the fourth patient, who had massive pulmonary fibrosis from asbestos lung disease, developed a respiratory tract infection and died from progressive respiratory failure. Open lung biopsy can be performed with minimal morbidity and a high diagnostic yield. The approach used in this series provides a safe and reliable operation with good cosmetic results.

Adult↗
PubMed1985

Bronchoscopic implantation of radioactive gold grains into endobronchial carcinomas.

We report the results of palliative treatment of non-resectable obstructing endobronchial carcinoma by bronchoscopic implantation of radioactive gold grains in 18 patients. Dyspnoea and collapse of a lobe or a lung were successfully treated in 13 cases where tumour was locally confined to a main or lobar bronchus. The response was maintained until death in nine of these patients but obstruction recurred in four longer surviving patients with tumours of main bronchus after a mean interval of 6 months. Treatment was less successful in five patients with tumour extending onto the trachea. The low penetration of interstitial radiation offers the advantage that normal lung and other tissues are not damaged, so that the procedure can be used in patients previously submitted to external radiotherapy.

Aged↗
PubMed1985

Thymolipoma in association with Hodgkin's disease.

Thymolipomas are rare mediastinal tumors. They have been described with a variety of systemic diseases. To our knowledge they have never been described in association with Hodgkin's disease. The significance of this association is unknown.

Adult↗
PubMed1984

Post-chemotherapy surgery in advanced non-seminomatous germ-cell testicular tumours: the significance of histology with particular reference to differentiated (mature) teratoma.

Of a total of 307 patients treated with chemotherapy for advanced non-seminomatous germ-cell testicular tumours between 1976 and 1983, 73 (23.8%) had masses excised after treatment. Resected tissue showed residual malignancy in 16 (22%), fibrosis and necrosis in 25 (34%) and differentiated (mature teratoma) in 32 (44%). Of the 16 patients with tumour only 7 (44%) are alive and disease-free compared with 21/25 (84%) and 27/32 (84%) for fibrosis/necrosis and differentiated teratoma respectively. In addition to histological evidence of residual tumour, elevated serum markers at the time of surgery and/or incomplete excision of residual masses were adverse prognostic features. Of 12 patients with differentiated teratoma or fibrosis who had incomplete resections or densely adherent masses excised with difficulty, 7 subsequently relapsed. The majority of differentiated teratoma patients (75%) had evidence of differentiation in their primary tumours; 88% showed cystic change in metastases and almost one-third showed an increase in the size of metastases during chemotherapy. The data suggest that post-chemotherapy surgery may have a therapeutic as well as a diagnostic role and that complete excision of residual disease should be attempted even if resection at one site has shown either fibrosis or differentiated teratoma. The significance of these findings in relation to treatment induced differentiation is discussed.

Combined Modality Therapy↗
PubMed1984

Effect of chemotherapy on the histological appearances of testicular teratoma metastatic to the lung: correlation with patient survival.

We report on 20 patients with teratoma of the testis metastatic to the lungs who underwent surgical enucleation of the pulmonary metastases. Seven patients showed predominantly undifferentiated tumour in the pulmonary metastases; six of these died within 26 months, while the seventh was lost to follow up. Four patients showed only scarring or total necrosis of their pulmonary lesions. These patients all received full courses of chemotherapy before surgery and are alive and well with no evidence of recurrence up to four years after diagnosis. In nine patients the pulmonary nodules consisted entirely of well differentiated tissues of benign appearance, sometimes resembling primary pulmonary adenochondromas. These patients also received full courses of chemotherapy before surgery; one died of disseminated disease but the other eight are all alive and well with survival intervals of up to 14 years after presentation. These findings show that following chemotherapy, necrosis and differentiation of teratomatous pulmonary metastases signify a good prognosis.

Humans↗
PubMed1984

Thymoma presenting as a middle mediastinal mass.

A case of a middle mediastinal mass which proved to be a thymoma is presented. The diagnostic difficulties that middle mediastinal masses produce and the investigations used to delineate them are discussed.

Humans↗
PubMed1983

Preoperative staging of lung cancer: accuracy of computed tomography versus mediastinoscopy.

Forty-four patients coming to surgery for carcinoma of the bronchus underwent preoperative staging of the mediastinum by computed tomography (CT scanning) and surgical exploration of the mediastinum by cervical mediastinoscopy or left anterior mediastinotomy or both. Where mediastinal nodes were affected the sensitivity and specificity of computed tomography was inferior to that of mediastinoscopy (57% and 85% versus 71% and 100%). The sensitivity of computed tomography in predicting mediastinal invasion was superior to that of mediastinoscopy (77% v 46%), especially in the case of lower-lobe tumours (67% v 17%). Mediastinoscopy had the considerable advantage of 100% specificity. In the assessment of hilar lymphadenopathy computed tomography had a sensitivity of 38% and a specificity of 64%. In cases where computed tomography showed a normal mediastinum or enlargement of the hilar glands only, mediastinal exploration conferred no additional information and could have been omitted. A computed tomography scan showing mediastinal abnormality is an indication for mediastinoscopy and not a contraindication to surgery. In 23 patients computed tomography showed some abnormality of the mediastinum, confirmed at mediastinoscopy in 12 cases. The remaining 11 patients underwent thoracotomy, resection being carried out in nine. Postsurgical staging showed that six of these tumours were N0 lesions without invasion; in two further N0 cases there was a minor degree of mediastinal invasion which did not prevent resection, and the remaining tumour was N1 without invasion.

Aged↗