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PubMed2004

Elevated serum epidermal growth factor receptor level in stage IV thymoma.

Using the enzyme immunoassay for epidermal growth factor receptor (EGFR), we investigated whether serum EGFR levels could be used as a predictor of the development and extension of thymoma. Serum samples were collected from 31 patients with thymoma and 16 patients with nonmalignant thoracic disease before clinical treatment. There was no difference between the serum EGFR levels of the patients with thymoma and the nonmalignant controls, being 49.1 +/- 136.3 and 22.6 +/- 7.3 fm/ml, respectively ( P = 0.11). However, patients with stage IV thymoma had significantly higher EGFR levels than those with stage I or stage II thymoma, the respective values being 127.8 +/- 243.9, 10.9 +/- 9.2 ( P = 0.02), and 19.7 +/- 10.6 ( P = 0.0433) fm/ml. The serum EGFR levels were similar in the pathological subtypes. These findings suggest that serum EGFR levels may serve as a marker that could be used as a diagnostic indicator of the invasion of thymoma.

Biomarkers, Tumor↗
PubMed2002

Elevated serum pro-MMP2 levels in patients with stage IV thymoma.

PURPOSE: There is increasing evidence that matrix metalloproteinases (MMPs) play important roles in tumor invasion and metastasis. Using a one-step sandwich enzyme immunoassay, we investigated whether serum pro-MMP2 levels could be predictors of the development and extension of thymoma. METHODS: The subjects of this study were 33 patients with thymoma and 26 patients with nonmalignant thoracic disease. RESULTS: Serum pro-MMP2 levels were elevated in patients with stage IV thymoma (938.6+/-80.2ng/ml) compared with those in the controls (P = 0.03). Patients with stage IVb thymoma had significantly higher serum pro-MMP2 levels than patients with other stages, being 1088.7+/-440ng/ml in stage IVb, 686.0+/-74.0ng/ml in stage I (P = 0.01), 685.8+/-48.6ng/ml in stage II (P = 0.01), and 691.7+/-74.0 ng/ml in stage III (P = 0.02). Serum pro-MMP2 levels were elevated in patients with polygonal cell type thymoma compared with those with mixed cell type thymoma, being 823.1+/-55.5ng/ml vs 613.6+/-59.9ng/ml, respectively (P = 0.04). Using the reference limit of 850ng/ml (mean +/- 2SD) set from analyses in the control group, all patients who had pro-MMP2 levels below the cutoff level survived. On the other hand, four of nine patients who had an elevated pro-MMP2 level died from recurrence. CONCLUSION: Serum pro-MMP2 levels may serve as a marker that could be used as an indicator of distant metastases in thymoma. Elevated pro-MMP2 levels may be correlated with poor survival.

Biomarkers, Tumor↗
PubMed2002

Anaphylaxis to cisplatin following nine previous uncomplicated cycles.

Anaphylaxis to cisplatin is an infrequent life-threatening complication which may occur even in patients who have received prior treatment with cisplatin. We report here a patient with carcinoma of the cervix with recurrent abdominal and thoracic disease who was previously treated with concurrent cisplatin and radiation for local control of pelvic disease. After nine previous uncomplicated cycles she developed severe anaphylaxis to cisplatin. The anaphylactic reaction was managed successfully with corticosteroids, nebulization with beta(2) agonists, and isotonic fluid support. With the extensive use of platinum-based chemotherapy regimens, either alone or in combination with radiation therapy in the management of gynecological malignancies, this uncommon complication should be kept in mind for early detection and successful management.

Anaphylaxis↗
PubMed2003

Elevated serum epidermal growth factor receptor level is correlated with lymph node metastasis in lung cancer.

BACKGROUND: Using an enzyme immunoassay for epidermal growth factor receptor (EGFR), we investigated whether serum EGFR levels could be used as predictors of the development and extent of lung cancer. METHODS: The study included 106 lung cancer patients and 16 patients with nonmalignant thoracic disease. Serum samples were collected before clinical treatment. RESULTS: There was no difference between serum EGFR levels in patients with lung cancer (21.275 +/- 22.035 fm/ml) in comparison with those in nonmalignant-disease controls (22.630 +/- 7.330 fm/ml; P = 0.8083). However, lung cancer patients with lymph node metastasis (23.515 +/- 20.065 fm/ml) had significantly higher EGFR levels compared with those in patients without lymph node metastasis (16.390 +/- 10.970 fm/ml; P = 0.0228). The serum EGFR levels were similar in samples from lung cancer patients with various pathological subtypes. There was no difference in the prognosis between the lung cancer group with normal EGFR levels (<850 ng/ml) and the group with elevated EGFR levels (>850 ng/ml). CONCLUSION: Serum EGFR levels may serve as a marker that can be used as an indicator of lymph node metastasis in lung cancer. However, there was no difference between levels in patients with lung cancer and those in nonmalignant-disease controls, indicating that the measurement of serum EGFR levels was of limited value in the detection of lung cancer.

Aged↗
PubMed1985

Long-term disability associated with flail chest injury.

Twenty-two trauma victims who had sustained flail chest as their only significant injury were evaluated to determine the final outcome. Fourteen patients (63.9 percent) were found to have long-term sequelae. The most common long-term problems after flail chest injury were persistent chest wall pain, chest wall deformity, and dyspnea on exertion. Five patients (22 percent) remained disabled in varying degrees.

Adult↗
PubMed1993

Thoracoscopic surgery: the Belgian experience.

Despite the already wide experience with video-assisted techniques in laparoscopic surgery, video-assisted thoracic surgery only recently came to be developed. This is clearly seen in a survey reflecting the experience among Belgian surgeons. A majority of the surgeons (63%) had limited experience (1 to 5 interventions), and only 28.5% had fairly considerable (between 11 and 20 interventions) or considerable (more than 20 interventions) experience. The majority of interventions performed were the treatment of pneumothorax, lung biopsies, wedge resections, and intrathoracic staging procedures, accounting for 209 (70%) of the 296 interventions collected in this survey. The remaining interventions display a wide variety of different thoracic procedures including lobectomy (4) and esophagectomy (20) for carcinoma. The overall technical success rate was 91% in this survey. Our own experience with 71 interventions or attempts reflects the same evolution with an overall technical success rate in 85% (60 patients). Pneumothorax was the most frequently performed intervention (35 patients), with a technical success rate of 94.5% (32 patients). Recurrences requiring further treatment occurred in 5 of the 32 patients (14.3%). All recurrences occurred before endostaplers were available, after which there were no failures in 12 consecutive cases. Other procedures successfully performed were lung biopsy/wedge resection (6), lung cancer staging procedures (3), lobectomy (1), hemothorax (3), chest wall neurinoma (2), sympathectomy (5), dorsal mediastinal neurinoma (1), thymectomy (1), esophagectomy (3), benign esophageal tumor enucleation (2), and Belsey Mark IV antireflux procedure (1). Furthermore, special emphasis was given to the development of video-assisted mediastinoscopy, which greatly facilitates teaching and interpreting this operation. Endoscopic myotomy using endostaplers was performed in 2 patients with Zenker's diverticulum. From our experience, however, it becomes clear that thoracoscopic approaches do not always result in a distinct benefit for the patient, as these procedures are more time consuming and usually require one-lung ventilation (probably the cause of the only fatal outcome in this series: a lung biopsy in an 85-year-old patient). In conclusion, video-assisted thoracic and thoracoscopic surgery is a new surgical modality offering new perspectives. However, careful patient selection and the same expertise as in open procedures are essential in determining the final outcome of each procedure.

Adult↗
PubMed1994

Traumatic thoracobiliary fistula.

Thoracobiliary fistulas are a commonly reported complication of subphrenic or liver abscesses and biliary tract obstruction. However, they are a rare and unusual complication of traumatic thoracoabdominal wounds. Due to their rarity, the experience of any one surgeon is minimal, and there is a paucity of information available in the literature regarding their treatment. We describe a case of a traumatic thoracobiliary fistula, review the existing literature, and discuss the proper management of this potentially lethal sequela of trauma.

Adolescent↗
PubMed1976

Apoprotein profile of plasma and chylous ascites lipoproteins.

Plasma and chylous ascites lipoproteins were compared in a rare case of exudative enteropathy associated with stenosis of the thoracic duct. All ascites lipoproteins separated by ultracentrifugation showed a much higher triglyceride/protein ratio and a lower cholesterol ester content than their plasma counterparts. Polyarcylamide gel electrophoresis of apoproteins before and after fractionation on Sephadex G-200 essentially showed, compared to normal plasma, a reduction of apoprotein C in VLDL and HDL particularly obvious for apoCIII1 and CIII2. Ascites lipoproteins were characterized by an increased apoA content in chylomicrons, VLDL and LDL and a reduced percentage of apo CII and CIII1, mostly in chylomicrons, VLDL and HDL. The differences in composition between plasma and ascites might be explained by different origins for the various apoprotein subfractions. The transsudation of chyle into the abdominal cavity might divert some peptides of intestinal origin from their normal entry into the circulation.

Apoproteins↗
PubMed1983

The use of computed tomography in evaluating chest wall pathology.

Forty-nine patients with chest wall lesions were evaluated by computed tomography (CT) and conventional radiography. Computed tomography was found to be indispensable for detecting and precisely localizing these lesions. It revealed unsuspected bone destruction and lung, pleural, and mediastinal involvement, as well as invasion of the spinal canal. In more than two thirds of the patients, CT provided additional information of clinical importance in management and, in one third, treatment was altered or the surgical approach modified because of the CT findings. Computed tomography is an essential diagnostic modality in evaluating chest wall lesions.

Adolescent↗
PubMed1992

A reappraisal of the role of prophylactic cranial irradiation in limited small cell lung cancer.

The use of prophylactic cranial irradiation in limited stage small cell lung cancer remains controversial. Prospective trials have demonstrated that PCI can reduce central nervous system relapse rates, but the impact on survival remains questionable except for the possible evidence of a beneficial effect for long term survivors. With higher rates of thoracic control now obtainable with hyperfractionated radiation and concomitant chemotherapy, it becomes important to analyze the benefit of PCI in that setting. Before 1982, we included PCI in the management of all patients with limited stage small cell lung cancer; thereafter, we discontinued its use. This report compares the outcome of the two treatment approaches and addresses the role of PCI among patients who achieve durable local control. There were 36 limited stage small cell lung cancer patients treated with PCI from 1979-1982 and 26 patients treated without PCI from 1985-1989. Induction chemotherapy was followed in both groups by thoracic irradiation (45 Gy). The PCI patients received 30 Gy to the whole brain in 10 fractions. Both groups received maintenance chemotherapy. Of complete responders, brain failure was the first failure in 18% (4/22) of PCI (+) versus 45% (10/22) of PCI (-) (p = .04). Survival at 2 years was 42% for PCI (+) versus 13% for PCI (-) (p less than .05). When the analysis was limited to those patients permanently controlled in the thorax; there were 25% (4/16) brain failures PCI (+) versus 70% (7/10) PCI (-) (p = .03). For this same subset the 2-year survival was 56% PCI (+) versus 14% PCI (-) (p less than .05). There were no 5 year survivors without PCI compared to 38% (6/16) with PCI. These data suggest that PCI appears to be effective in enhancing survival of patients who achieve durable thoracic control. Prospective trials are necessary to evaluate the use of PCI combined with therapeutic regimens with a documented ability to achieve high rates of sustained control of thoracic disease.

Brain↗
PubMedDate not supplied

Xiphodynia: a report of three cases.

Xiphodynia is an uncommon musculoskeletal disorder that mimics a number of common abdominal and thoracic diseases. We report three cases of xiphodynia. The diagnosis is suggested when a given patient's chest or abdominal discomfort is completely or almost completely reproduced with light pressure on the xiphoid process. Local injection with an anesthetic-steroid combination is frequently curative. No more than 5 to 7 mL of solution should be injected, and results are variable when several trigger points are found on the anterior chest wall. Tack hammer deformity of the xiphoid, another cause of xiphoid pain, has been successfully treated with surgical excision.

Adult↗
PubMed1994

Retrospective analysis of the utility of video-assisted thoracic surgery in 100 consecutive procedures.

One hundred consecutive video-assisted thoracic surgery (VATS) procedures, diagnostic (n = 54) and therapeutic (n = 46), in 90 patients over a 2-year period are reviewed. Hospital mortality was 2%. Conversion to formal thoracotomy was required in 3%, and re-exploration for bleeding in 1%. Seven patients required intensive care unit facilities postoperatively. The technique described was safe and there was minimal postoperative morbidity. Diagnostic VATS was of particular use in cases of indeterminate pulmonary masses (Sensitivity of 96%), anterior mediastinal masses and in immunocompromised patients. Video-assisted thoracic surgery may now be the treatment of choice for recurrent pneumothoraces and it demonstrated potential for development in a variety of other benign thoracic disorders. This method had a limited role in the management of empyaema with a 60% conversion rate to formal thoracotomy. Pulmonary resections were feasible but its role in the treatment of malignancy is questioned.

Adolescent↗
PubMed2004

Imaging of pleural fluid in healthy individuals.

AIM: The aim of the present study was to determine the ability of radiography and ultrasonography to detect normal pleural fluid in healthy individuals and to assess the frequency of this finding. MATERIALS AND METHODS: Chest ultrasonography of both pleural spaces was performed in a group of 106 healthy volunteers to identify pleural fluid, first in the lateral decubitus position and than leaning on one elbow. Posteroanterior (PA) and lateral decubitus expiratory radiography were subsequently performed. An anechoic layer at least 2 mm thick on chest ultrasonography and a density with a horizontal level at least 3 mm in depth on lateral decubitus radiography were taken as positive results. RESULTS: On ultrasonography the fluid layer with a typical wedge-shaped appearance was visible in the pleural space of 28 of 106 (26%) volunteers, on both sides in 17 of 28 (61%) and unilaterally in 11 of 28 (39%). The mean fluid layer thickness in both positions was 2.84 mm (SD 0.41 mm, range 2.0-4.3 mm). Mean thickness in the decubitus position was found to be significantly larger than in the elbow position (P < 0.01). Lateral decubitus expiratory radiography showed physiological pleural fluid in only one case. CONCLUSION: Chest ultrasonography is superior to lateral decubitus expiratory chest radiography for demonstrating small amounts of normal pleural fluid in healthy individuals. A positive result, if detected, should not be taken as a sign of occult thoracic disease.

Adult↗