PubMed · 6568994
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L S Manvelov. 1984. [Polyneuropathy in systemic scleroderma].. https://pubmed.ncbi.nlm.nih.gov/6568994/
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The treatment of esophageal disruptions has changed since 1981. The value of a more selective assessment in six spontaneous ruptures and 30 mostly intrathoracic (83.4%) esophageal perforations is evaluated in this study. Based on the previous state of the esophagus, the time factor, and type and site of the disruption, reinforced primary repair (by diaphragmatic, muscular, pleural flap, or fundoplication), transhiatal closure, resection, intubation, suture combined with myotomy and fundoplication, esophageal diversion, and transhiatal mediastinal drainage were employed. The overall 30-day hospital mortality was 19.4%. Although these operations were mostly used in late (24 h to 7 months) perforations and ruptures, none of the patients with reinforced repair by autogenous diaphragmatic, muscular, or pleural flaps or fundoplication had fatal outcome for breakdown of the closure. Only patients with renal, cardiac, or multiorgan failure as a consequence of sepsis due to time elapsed before hospital admission died. The key to improve the prognosis of this life-threatening emergency is the more appropriate selection of the primary employed procedure.
Lymphoma, mediastinal cysts, and neurogenic neoplasms are the most common primary middle and posterior mediastinal tumors. Lymphoma may involve the anterior, middle and/or posterior mediastinum, frequently as lymphadenopathy or as a discrete mass. Foregut cysts are common congenital mediastinal cysts and frequently arise in the middle mediastinum. Pericardial cysts are rare. Schwannoma and neurofibroma are benign peripheral nerve neoplasms, represent the most common mediastinal neurogenic tumors, and rarely degenerate into malignant tumors of nerve sheath origin. Sympathetic ganglia tumors include benign ganglioneuroma and malignant ganglioneuroblastoma and neuroblastoma. Lateral thoracic meningocele is a rare cause of a posterior mediastinal mass.
PURPOSE: Combined modality therapy has become the standard oncologic approach to achieve organ preservation in many malignancies. METHODS AND MATERIALS: Although radical cystectomy has been considered as standard treatment for invasive bladder carcinoma in the United States, good results have been recently reported from several centers using multimodality treatment, particularly in patients with clinical T2 and T3a disease who do not have a ureter obstructed by tumor. RESULTS: The components of the combined treatment are usually transurethral resection of the bladder tumor (TURBT) followed by concurrent chemotherapy and radiation therapy. Following an induction course of therapy a histologic response is evaluated by cystoscopy and rebiopsy. Clinical "complete responders" (tumor site rebiopsy negative and urine cytology with no tumor cells present) continue with a consolidation course of concurrent chemotherapy and radiation. Those patients not achieving a clinical complete response are recommended to have an immediate cystectomy. Individually the local monotherapies of radiation, TURBT, or multidrug chemotherapy each achieve a local control rate of the primary tumor of from 20 to 40%. When these are combined, clinical complete response rates of from 65 to 80% can be achieved. Seventy-five to 85% of the clinical complete responders will remain with bladders free of recurrence of an invasive tumor. CONCLUSIONS: Bladder conservation trials using combined modality treatment approaches with selection for organ conservation by response of the tumor to initial treatment report overall 5-year survival rates of approximately 50%, and a 40-45% 5-year survival rate with the bladder intact. These modern multimodality bladder conservation approaches offer survival rates similar to radical cystectomy for patients of similar clinical stage and age. Bladder-conserving therapy should be offered to patients with invasive bladder carcinoma as a realistic alternative to radical cystectomy by experienced multimodality teams of urologic oncologists.