Septum transversum diaphragmatic hernia in an adult.
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Biomedical subjects
Publications and source records attributed to Valerio Annessi.
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BACKGROUND: Large cell neuroendocrine carcinoma is a recently recognized histologic entity whose clinical features and optimal treatment have not yet been well defined and are still being assessed. We report our retrospective assessment of cases of large cell neuroendocrine carcinoma observed from 1989 to 1999 in terms of survival. METHODS: Cases of large cell neuroendocrine carcinoma diagnosed between 1989 and 1999 were reassessed retrospectively according to the World Health Organization classification. The clinical outcome and pathologic features of all cases are described. Survival rates of patients with large cell neuroendocrine carcinoma are compared with those patients with small cell lung cancer treated in the same period. RESULTS: Patients were 41 men and 7 women with an average age of 63.7 years. Twenty-nine patients (60.4%) had pathologic stage I disease, 11 patients (22.9%) had pathologic stage II disease, and 7 patients (14.6%) had pathologic stage IIIA disease. One patient (2.1%) had pathologic stage IIIB disease. No patient underwent induction chemotherapy. Two patients underwent adjuvant chemotherapy and 2 underwent mediastinal radiotherapy for N2. No death was reported in the perioperative period. The median follow-up was 5 years. The actuarial survival for the entire group was 60.4% at 1 year, 27.5% at 3 years, and 21.2% at 5 years. The actuarial survival of accurately staged, stage I patients at 5 years was 27%. CONCLUSIONS: The findings suggest that treating large cell neuroendocrine carcinoma by means of applying treatment for nonsmall cell lung cancer leads to a prognosis that is worse than that for nonsmall cell lung cancer, even in terms of low pathologic stages.
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Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the preferred sites of such metastases are the heart, pericardium, lung, breast, liver, spleen, bone, and brain. In rare cases the lung has been described as the primary site. The prognosis of this neoplasm is extremely poor. We report a case of epithelioid angiosarcoma with multiple bilateral lung infiltration, bone metastasis, and metastasis of the lamina propria of a tubulovillous adenoma of the colon.
Residual thoracic collections after thoracic traumas occur in 5-30% of patients and are a major risk factor for development of empyema. Management with a thoracostomy tube is the traditional treatment but it requires a prolonged hospital stay and 20% of patients treated continue to have a residual clot. Forty-two haemodynamically stable patients with chest trauma (36 blunt and 6 penetrating) were examined thoracoscopically. Indications for videothoracoscopy included suspected diaphragmatic injury (8 patients), persistent pneumothorax (8), continued haemorrhage (6) and clotted haemothorax (20). Diaphragmatic lacerations were confirmed thoracoscopically in 7 patients. Four of them were successfully repaired with thoracoscopic techniques and three were repaired after conversion to open thoracotomy for large diaphragmatic lacerations. In patients with persistent pneumothorax, limited lung lacerations were correctly diagnosed and repaired thoracoscopically. In all patients with continued haemorrhage intercostal artery injury was confirmed and repaired by diathermy. All clotted haemothorax cases were successfully evacuated. No complications occurred. Videothoracoscopy appears to be a safe, accurate and reliable operative therapy for the assessment of diaphragmatic injuries, control of continued bleeding and evacuation of clotted haemothorax, reducing the hospital stay and possible complications.
While liposarcoma is the most common malignant mesenchymal neoplasm in adults, a mediastinal position is rare. We describe here the case of a 74-year-old female with an hourglass-shaped mass in the posterior mediastinum, which was probably present on a roentgenogram 4 years earlier. On a CT scan of the chest, the mass appeared non-homogeneous with a mainly adipose content. A preoperative ultrasonically guided tru-cut transthoracic biopsy revealed the presence of adipose tissue with mildly atypical cytological features. The mass was therefore completely excised by means of a right thoracotomy. The postoperative course was uneventful and the patient is alive and well and has had no recurrence in the 6 months since surgery. We review here the natural history, pathology, and prognosis of the disease, and discuss methods of diagnosis and management of such lesions.
The various techniques used to perform percutaneous guided biopsies of mediastinal masses have already been amply described, with particular attention to the type of needle used. In this study our experience with mediastinal transthoracic core needle biopsy has been compared with reported descriptions of ultrasonically guided fine needle aspiration to determine which is better and the respective influence on pathological diagnosis. Between January 1998 and July 2002, 47 patients underwent anterior mediastinal core needle biopsy with ultrasonic guidance. An accurate diagnosis was achieved in all patients, with 100% sensitivity and specificity. In all patients with lymphoma and thymoma it proved possible to establish the histological type. Two cases of pneumothorax were seen with pleural drainage and a 5-day hospital stay required in one of the cases. The remaining 45 patients were treated as outpatients and were discharged within 4 hours of the procedure. Ultrasonically guided percutaneous needle biopsy is a safe procedure; fine needle aspiration usually suffices for solid malignant lesions while a core needle biopsy should be performed when lymphoma or thymoma masses are suspected in order to obtain larger specimens for a precise histological diagnosis. The core needle procedure avoids repetition of unsuccessful fine- needle aspirations and reduces the number of mediastinoscopies and videothoracoscopies carried out for diagnostic purposes.
The present international system for staging lung cancer classifies multiple pulmonary nodules present in one pulmonary lobe or in distinct ipsilateral or controlateral pulmonary lobes as stage IIIB and IV, respectively. In our opinion this approach does not guarantee the patient the best choice of therapy. Moreover, some studies support the choice of surgery for patients with multiple pulmonary nodules without mediastinal lymph node involvement. Introducing PET may be of considerable help in making an informed choice. In this work we propose a diagnostic/therapeutic decisional algorithm for patients with multiple pulmonary nodules.