Showing papers on "Mediastinoscopy published in 1979"

Development of Brain Metastases in Small-Cell Anaplastic Carcinoma of the Lung

Abstract: Small-cell anaplastic carcinoma (sm.a.c.) of the lung, unlike other types of lung cancer, is known to disseminate very early and widely. Evidence for this comes from staging procedures, such as mediastinoscopy, bone marrow examination and peritoneoscopy with liver biopsy (Selawry and Hansen, 1973). The brain is also a frequent site for distant metastases in sm.a.c. with an incidence of approximately 10 per cent at the time of diagnosis (Newman and Hansen, 1974; Reed and Livingston, 1977) and 29 to 50 per cent at autopsy (Line and Deeley, 1971; Takita et al., 1973; Eagan et al., 1974; Auerbach et al., 1975). Within the last five years considerable progress has been made in the treatment of this disease by the use of combination chemotherapy resulting in a significant prolongation of life (Hansen, 1977). During this period brain metastases have emerged as a specific therapeutic problem, presumably because some of the most active compounds against this disease cross the blood-brain barrier poorly, thereby leaving the brain as an unprotected reservoir for metastatic seeding. Accordingly, detailed information on the development of brain metastases in patients with sm.a.c. is important.

Mediastinal lymph node biopsy in sarcoidosis.

Abstract: Mediastinoscopy, in the skilled hands of a thoracic surgeon has proved to be a safe, cosmetically accepted procedure with negligible complications. It has yielded a high rate of diagnostic lymph node tissue; overall greater than 82% among patients with sarcoidosis, including patients presenting with pulmonary mottling only or with a normal chest radiograph. Among patients with lymphatic tuberculosis it enabled the isolation of human M. tuberculosis following culture of the lymph node removed on Lowenstein-Jensen medium in greater than 79% of cases. A precise histological diagnosis was obtained in all 14 patients presenting with hilar and/or paratracheal lymphadenopathy attributable to malignant disease.

Right radial artery pressure during mediastinoscopy.

Abstract: Mediastinoscopy has been recommended in all patients prior to thoracotomy for pulmonary carcinoma.' The technique for mediastinoscopy originally described by Carlens2 and with various modificat i o n ~ ~ ' has proven to have a morbidity of less than a%.', Compression of the innominate artery during mediastinoscopy with loss of the right radial pulse has led to the erroneous diagnosis of cardiac arrest.6 One case of transient left hemiparesis has been reported and was attributed to compression of the innominate artery by the mediastino~cope.~ Early investigators5 recommended monitoring of the right radial pulse because of innominate artery compression during \"vigorous retraction on the mediastinoscope.\" Recently, Lee and Salvatore' have advocated constant monitoring of the right radial pulse by plethysmography and judicious monitoring of the carotid artery blood flow by Doppler probe in patients with significant arteriosclerotic disease. Frequency and duration of alterations in right radial artery pressure during mediastinoscopy have not been documented and are the purpose of this study.

The indications for transcervical mediastinoscopy in patients with small peripheral bronchial carcinoma.

Abstract: A series of 80 patients with roentgenographic evidence of bronchial carcinomas 3 centimeters or less in size was analyzed as to the incidence of mediastinal lymph node metastases. Forty patients underwent transcervical mediastinoscopy prior to thoracotomy and 40 patients did not. Three patients with large cell undifferentiated carcinoma had mediastinal lymph node metastases which could be detected by transcervical mediastinoscopy. None of the 40 patients who did not undergo mediastinoscopy had palpable evidence of mediastinal lymph node metastases at thoracotomy. The survival rates for the two groups of patients were similar. On the basis of this study, we have concluded that mediastinal exploration is not routinely indicated in patients with peripheral T1, N1, M0 lesions.

Diagnostic value of fiberoptic bronchoscopy in lung cancer presenting as mediastinal mass(es).

Abstract: The diagnostic yields of prebronchoscopy sputum specimens and fiberoptic bronchoscopy (including brushings, washings, and/or biopsies) were determined in 35 patients who presented primarily with middle or anterior mediasttnal and/or paratracheal mass(es) on chest radiographs. The diagnosis was confirmed on histopathology of tissue obtained by needle biopsy, mediastinoscopy, thoracotomy, and/or autopsy. Thirty-one of the patients were found to have primary bronchogenic carcinomas. At bronchoscopy, extrinsic compression of trachea and/or bronchi was visualized in 23 (Group I) and the tracheobronchial tree appeared normal in 12 (Group II). Prebronchoscopy sputa gave a positive yield in only three of the 35 (8%) patients; the yield was similar in both groups of patients. One or more of the bronchoscopic modalities were diagnostic in 69% of Group I patients but were not helpful in Group II patients. The diagnostic yield of brushings, washings, and biopsies in Group I patients was 52%, 61%, and 37%, respectively. The addition of biopsies to washings and/or brushings did not significantly alter the yield. Washings and brushings are recommended as useful, non-invasive procedures in diagnosing middle mediastinal masses with extrinsic compression. Sputum cytology gives a very low yield.

Bronchial Angiography in the Staging of Bronchogenic Carcinoma

Abstract: Selective bronchial angiography was performed in 26 patients with bronchogenic carcinoma in connection with intraarterial infusions of cytostatic drugs. The angiographic extension of the tumor was correlated to data obtained at surgery, mediastinoscopy or autopsy. Bronchial angiography is not suitable as a routine procedure in the preoperative evaluation of patients with bronchogenic carcinoma but may contribute to a more precise staging of the tumor.

[Bronchiolo-alveolar cell carcinoma].

Abstract: 15 cases of bronchiolo-alveolar cell carcinoma were observed at the Dept. of Surgery of the University Hospital of Zurich from 1961 to 1976. The mean age of these patients was 56 years. The sex distribution was 13 males and 2 females. Five cases were discovered accidentally; the symptoms of the remaining 10 were uncharacteristic. Cytology, bronchoscopy and mediastinoscopy were negative at early stages. Diagnosis was made by histologic examination of the specimens only. Needle biopsy, performed routinely over recent years, proved helpful in 4 cases. In 12 out of 14 patients, lobectomy was considered 'radical'; nevertheless, only 2 survived more than 5 years. The disseminated form of the bronchiolo-alveolar cell carcinoma is characterized by a particularly poor prognosis. According to our experience and to the literature, only the solitary, nodular type shows a more favourable outlook.

[Bronchial arteriography and intraarterial chemotherapy in bronchogenic carcinoma (author's transl)].

Abstract: Selective bronchial angiography and short term intra-arterial infusions of Mitomycin C were performed in 70 patients with bronchogenic carcinoma. The courses were given 1--5 times with a median interval of 2 weeks. The angiograms were compared with chest radiograms and data obtained at bronchoscopy, mediastinoscopy, surgery or autopsy. The effect of therapy was evaluated with chest radiography and bronchoscopy. Among our first 36 patients an objective response was registered in 18/27 patients with squamous cell carcinoma, in 4/7 with adenocarcinoma and in 2/2 with small cell cancer. These results warrant further studies. Though not suitable as a routine procedure in the diagnostic work up of a patient with possible bronchogenic carcinoma bronchial angiogrpahy may contribute to a better staging when used e.g. in connection with intraarterial chemotherapy.

[Mediastinoscopy in haematosarcomas (author's transl)].

Abstract: Mediastinoscopy allows mediastinal examination through a cervical pathway. 17 mediastinoscopies were performed on 15 children with lymphomas (5 Hodgkin disease, 10 non Hodgkin malignant lymphomas). The diagnosis was assessed by mediastinoscopy on 10 patients which had only an abnormal mediastinal opacity and were free from extrathoracic localisation. This endoscopy was done on 5 children associated with a staging laparotomy to establish a prognosis and to investigate the spread of the disease before or during treatment. Diagnosis was obtained in 14 of the 15 patients. No surgical complications was observed. However, emergency care was necessary after two anaesthesical accidents in 2 children with malignant lymphomas. Mediastinoscopy is unfrequently required in children. Although in non surgical disease such as lymphomas, it may avoid an unnecessary thoracotomy and be repeated without damage.

[Clinical protocol for study and treatment of bronchogenic carcinoma (author's transl)].

Abstract: Bronchogenic carcinoma constitutes one of the primary causes of death in our population. The only means of controlling the disease in a significant way is by surgery, which about a third of the patients undergo. This fact, together with the age at which the pathology appears, its frequent association with chronic pulmonary disease, and the rapidity of its metastatic spread, make it necessary to establish a protocol for the study, diagnosis, and treatment of bronchogenic carcinoma. These norms should be applicable in prospective epidemiologic studies and for evaluating methods of diagnosis and treatment. The Interhospital Bronchogenic Carcinoma Co-operative Group has established a protocol, which includes the criteria of operability, resectability, preoperative examinations, indications of mediastinoscopy, etc. The authors mention the histopathologic classification, the TNM criteria, and the characteristics of localized or advanced disease.

Complications following mediastinoscopy. Prevention and therapy

Abstract: Mediastinoscopy, being practised since 20 years, is a research method giving a high degree of information and during this time has become indispensable in diagnosis of diseases of the chest. The close neighbourhood of vital organs, small and easily vulnerable blood vessels and nerval tissues of functional importance first seemed to burden this method of investigation with an incalculate risk. But subtle operative technique with its instruments by Carlens and others let the number of complications remain remarkably small even in great collective statistics. The number of lethal complications ranged below 0.2%, more severe ones about 1%. But in these latter ones one almost always succeeds in achieving a restitutio ad integrum bei performance of consequent after-treatment. The more frequent mediastinoscopic investigations are performed in regions of marked pathologic changes, the higher is the number of described complications. But it must be considered that in many cases the more perilous and functionally straining thoracotomy can be avoided using mediastinoscopy. Complications occurring most frequently are described and possibilities of therapy are discussed.