[10 years' experience with Stemmer's parasternal mediastinotomy].
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Disagreement continues about the role of immediate irradiation of asymptomatic patients with inoperable lung cancer. Information pertaining specifically to irradiation of asymptomatic patients is scarce. The Medical College of Wisconsin, Milwaukee, reported that survival two years after irradiation was affected by control of the intrathoracic tumor. Ninety-two patients from that study with high performance status (80 to 100 on the Karofsky scale) were evaluated for long-term survival. Of 54 patients (59%) whose tumors were controlled locally by irradiation, 22% survived five years. None of the 38 patients with uncontrolled thoracic disease lived beyond 27 months. Eight patients are alive and well 53 to 100 months after treatment. No specific late complications of irradiation have been seen. Patients having few symptoms with inoperable bronchial carcinoma can live many years if the tumor is controlled by irradiation.
The orienting investigation should be a compulsory component of every internist echographic status with the rapid B picture. Besides its diagnostic aspects, thoracic echography with the rapid B picture in the region of the pericardium is also of therapeutic importance for the reliable specific ultrasonic pericardial puncture for the relief a tamponading pericardial effusion. All radiological shadows which are not completely clear must be subjected to echographic assessment before proceeding to more expensive diagnostic measures. This permits the sonographic differentiation between a collection of fluid and a solid structure as far as the shadows are confined to the wall.
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The thoracic inlet is insufficiently investigated by conventional radiographic techniques. CT clearly demonstrates this area free of superimposition. Thorough knowledge of cross sectional anatomy is essential for CT interpretation. There is a wide spectrum of pathology involving the thoracic inlet because its visceral, lymphatic, vascular and nervous structures are connected with many parts of the body. An overview is given on the indispensable role of CT in the investigation of the various pathological entities involving the thoracic inlet.
Fourteen patients with bony lesions of the thoracic wall, seven benign and seven malignant, were evaluated. In lesions with an aggressive appearance on plain films, computed tomography proved to be very accurate for mapping their extent, and for evaluating adjacent organ involvement. For non-aggressive bony lesions of the chest wall, plain films are sufficient for determining the nature of the lesion.