What is the best treatment for early operable small cell carcinoma of the bronchus?
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A study has been made of 8781 patients with bronchial carcinoma who were operated on by seven surgeons in England during the years 1949-80. There were 3865 pneumonectomies, 3790 lobectomies, and 1126 thoracotomies. During this period the operative mortality has fallen. Neither the resection rate nor the proportion of lobectomies bears any relation to the survival rate in any series. There has been remarkable similarity between the various survival rates in that the difference at five years was only 1.3% (25.5-26.8%) and at 10 years 4.2% (13.6-17.8%). These figures are reflected in reports published worldwide, where there is also great similarity between the results. If the improvement in operative mortality is excluded, there has been no improvement in the survival rates in the last thirty years.
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Granular cell tumours are uncommon, generally benign neoplasms of uncertain origin that occasionally affect the tracheobronchial tree. Their incidence seems to be increasing, despite the fact that such tumours are rarely suspected on clinical grounds or bronchoscopic appearance. Here we describe three cases of endobronchial granular cell tumours, one of which regressed spontaneously after biopsy, and review previous accounts of their bronchoscopic and clinical features.
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An argyrophil technique for the demonstration of nucleolar organiser regions has been applied to routinely processed paraffin sections of 15 specimens of small cell carcinoma and 15 biopsy specimens infiltrated by lymphocytes. To avoid tautological problems, the nature of the specimens was confirmed by means of immunohistochemical staining for neurone specific enolase and leucocyte common antigen. The specimens of small cell carcinoma were readily differentiated from those containing lymphocytes by the argyrophil method, the range of mean number of nucleolar organiser regions per nucleus being 4.2-7.3 for small cell carcinoma cells and 0.9-1.7 for lymphocytes. This method separates malignant epithelial cells from benign lymphocytic cells and has potential in both clinical and research investigation of respiratory tumours.
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Growth hormone is a secretory product of some primary bronchial neoplasms and has been associated with the development of hypertrophic pulmonary osteoarthropathy and acromegaly in occasional patients with such tumours; it has not, however, generally been considered important in the pathogenesis of digital clubbing. Plasma levels of growth hormone at the time of diagnostic bronchoscopy were measured in 60 patients with histologically proved bronchial carcinoma, divided according to whether clubbing was present (n = 21) or absent (n = 39), and in 13 control subjects undergoing the same procedure but with no neoplasm. The median plasma level of growth hormone ( and interquartile range) was 0.74 (0.5-1.0) mU/l in five control subjects with no pulmonary disease, 0.83 (0.4-1.3) mU/l in eight subjects with non-neoplastic pulmonary disease, 1.1 (0.6-3.3) mU/l in patients with carcinoma but without clubbing, and 3.1 (0.8-9.0) mU/l in 21 patients with carcinoma and clubbing. The highest growth hormone level was seen in a patient with a small cell carcinoma and pronounced clubbing; levels had fallen to normal by the time chemotherapy was completed and clubbing completely resolved. Thus growth hormone or a similar substance might have a role in the pathogenesis of clubbing in patients with bronchial neoplasms.
A rare case of a peripheral pulmonary adenoid cystic carcinoma is presented. Histological examination after lobectomy showed pronounced submucosal invasion of the carcinoma to proximal bronchi.
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Foreign bodies lodged in the bronchial tree are normally retrieved by bronchoscopy, but if this fails then thoracotomy is necessary. The case history is presented of a patient who had inhaled a dental post which could not be retrieved either by flexible or rigid bronchoscopy. Using biplane screening and intravascular retrieval devices introduced via an endotracheal tube, the dental post was removed successfully without the need for thoracotomy.