Biomedical subjects
Y Lieberman
Publications and source records attributed to Y Lieberman.
Pediculated small cell tumor of upper esophagus.
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[Esophageal perforation].
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Percutaneous tube drainage: the treatment of choice for refractory lung abscess.
During the years 1978 to 1982, 48 patients with primary lung abscess were seen in the Sheba Medical Center in Israel. Seven of them (14%) did not respond to conservative treatment and were candidates for operation. All were successfully treated by percutaneous tube drainage initiated under local anesthesia, and all recovered completely. There were no relapses after a follow-up period of 2 to 5 years. During this period, we did not perform pulmonary resection for primary lung abscess. Three patients with malignant abscesses were also treated initially by transthoracic drainage but eventually required surgical intervention. We conclude that percutaneous transthoracic drainage is an efficient and safe mode of treatment, and we recommend transthoracic drainage as the treatment of choice for long-standing, refractory primary lung abscesses.
Prognosis of patients with adenocarcinoma of the lung and mediastinal lymph node metastases undergoing pulmonary resection.
Of 57 patients who were operated on for adenocarcinoma of the lung during the period 1966-1970, 18 with mediastinal lymph node metastases successfully underwent potentially curative pulmonary resection combined with complete mediastinal lymph node dissection. The 5-year survival rate was nil. In light of this poor outlook, we do not recommend surgery as the primary treatment of choice in patients with adenocarcinoma of the lung and known mediastinal lymph node metastases.
Autoimmune hemolytic anemia as the presenting manifestation of malignant thymoma.
Severe autoimmune hemolytic anemia is described as the presenting manifestation of malignant thymoma. The hemoglobin level was 5.7 g/dl, the direct IgG antiglobulin test (direct Coombs' test) was strongly positive and the indirect Coombs' test was weakly positive. Prompt remission of the hemolytic process was achieved by thymectomy combined with corticosteroid therapy; the hemoglobin level rose to 12.2 g/dl and both the direct and indirect Coombs' tests became negative. To our knowledge, this is the first case to be described in which autoimmune hemolytic anemia was the presenting manifestation of malignant thymoma. Autoimmune hemolytic anemia may be considered as a manifestation associated with malignant thymoma.
Pulmonary resections in patients over 70 years of age.
Fifty-one men and 7 women greater than 70 years of age (mean 72.3) underwent pulmonary resection over a 5-year period. Fifty-two of these patients had a malignancy, of which 48 were primary lung neoplasms, including 42 cases of non-small-cell lung cancer. The overall operative mortality rate was 10.3%. Mortality was correlated with several preoperative factors, including pulmonary function tests, arterial blood gas tension, age, extent of surgery, stage of disease, and additional systemic diseases. Only the extent of surgery (mortality of 36.4% for pneumonectomies compared with 4.3% for less extensive resections, P less than 0.01) and FEV1/VC (the ratio of forced expiratory volume in 1 sec to vital capacity) (P less than 0.05) had statistical significance. The 5-year survival rate for patients with primary lung malignancies was 40%. In view of the aggressive nature of lung tumors in any age-group, the life expectancy of greater than 10 years at age 70, and the reasonable operative risk compared with the high mortality rate in patients not operated upon, we advocate surgical treatment for most patients greater than 70 years of age with a curable disease.
Asymptomatic pulmonary nodule in sarcoidosis.
A case of an asymptomatic solitary pulmonary nodule which proved to be due to sarcoidosis, is described. Only an excisional biopsy can establish the diagnosis. Sarcoidosis, although rare, must be added to the differential diagnosis of asymptomatic solitary pulmonary nodule.
[Neurofibrosarcoma of the posterior mediastinum in neurofibromatosis].
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Distinctive immunofluorescent labeling of epithelial and mesenchymal elements of carcinosarcoma with antibodies specific for different intermediate filaments.
A carcinosarcoma of the lung, as well as the paratracheal lymph nodes from the same patient, were subjected to immunofluorescent labeling with antibodies to tissue-specific intermediate-filament subunits, including desmin, vimentin, and prekeratin. Within the tumor mass two distinct populations of malignant cells were found: prekeratin-positive cells, corresponding to the carcinomatous component of the tumor, and vimentin-positive cells, corresponding to the sarcomatous elements. Tumor cells were also detected in lymph node metastases in which only the prekeratin-containing carcinoma cells were found. In view of the strict specificity of antivimentin and anti-prekeratin for cells of mesenchymal or epithelial origin, respectively, it is proposed that the two components of the carcinosarcoma are derived from distinct cell types and are not morphologic variants of the same tumor.
Diaphragm mobilization for closure of chest wall defects.
Locally disseminated breast carcinoma after a simple or radical mastectomy and radiotherapy causes serious surgical problems. Excision of the chest wall obliterates the negative intrapleural pressure, and wound healing within a previously irradiated area is notoriously poor. A new method is described in which the diaphragm is mobilized and reinserted into the defect to allow final resurfacing with a skin graft or locally rotated skin flap. This simple surgical method is advocated when the prognosis is poor and breast reconstruction is not being considered.
Review of smooth muscle tumours of the lower respiratory tract.
A case of leiomyoma of the lung was described by our department 17 years ago. We now report three new cases of smooth muscle tumours of the lower respiratory tract: a leiomyoma of the lung, a leiomyosarcoma of the right main bronchus, and a leiomyoma of the trachea. Whereas in the previous case the tumour was bronchoscopically removed, all the recent tumours were surgically resected. All the patients have done well, including the one with the leiomyosarcoma who underwent surgery 7.5 years ago. One hundred and eighty cases of leiomyoma and leiomyosarcoma of the lung and trachea have been reported to date. Pulmonary leiomyoma most commonly presents as an asymptomatic solitary lung nodule. The endobronchial variety may cause cough, haemoptysis, or shortness of breath. Most of these tumours were dealt with by major pulmonary resection, although a lesser resection would have sufficed in many cases if a histological diagnosis had been established prior to surgery. Pulmonary leiomyosarcoma may occur at any age, and is much more common in females. The majority of the patients have thoracic symptoms. These neoplasms seem resistant to chemotherapy or radiotherapy and should be treated by radical resection whenever possible, which results in a 45% 5-year survival rate. Only seven cases of leiomyosarcoma and 12 cases of leiomyoma of the trachea have been reported. These usually cause respiratory obstruction and/or haemoptysis. The malignant as well as the benign tumour is probably best treated by complete surgical resection.
Percutaneous drainage of lung abscess.
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An unusual case of empyema; intrapleural migration of an inhaled oat head in an adult.
We report an unusual case of unnoticed aspiration of an oat head by a healthy 19-year-old male. The foreign body migrated to the right pleural cavity and caused a severe persistent empyema, which resolved only after a thoracotomy . The lodging of a grass head in the pleura is a very rare event, almost never reported in an adult.
Spontaneous pneumomediastinum: is it a rare cause of chest pain?
A policy of obtaining a routine chest radiograph in every young patient with unexplained chest pain or dyspnoea led to the diagnosis of 14 cases of spontaneous pneumomediastinum within four years, whereas only two cases from former years could be found retrospectively. One patient had recurrent spontaneous pneumomediastinum, the first case so far reported. Analysis of admission data suggested that this entity may be much more common than is generally believed, and may be second only to spontaneous pneumothorax as a cause of admission of young, healthy individuals experiencing sudden chest pain or shortness of breath. After reviewing the published reports we propose the following definition of spontaneous mediastinal emphysema: the non-traumatic presence of free air in the mediastinum in a patient with no known underlying lung disease. When it occurs without associated pneumothorax it is benign. The incidence of spontaneous pneumomediastinum for the four-year period under study was 1 per 12 850 admissions.
Recurrent spontaneous pneumomediastinum. The first reported case.
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Chondrosarcoma of the bronchus.
A primary chondrosarcoma of the right main bronchus was removed by pneumonectomy in a 74-year-old woman. The presenting symptoms were dyspnea and cough with a lung mass evident for 18 months. She is well and free of tumor 16 months later. Only eight established cases of primary chondrosarcoma arising from the lung, and four originating from the tracheobronchial tree have been previously described. The long preoperative history and the outcome so far confirm the relatively less aggressive character of the tracheobronchial as compared to the lung subdivision of primary pulmonary chondrosarcoma.
Segmental study of the terminal coronary vessels in coarctation of the aorta: a natural model for study of the effect of coronary hypertension on human coronary circulation.
An electron microscopic study of the coronary terminal circulation (starting with the small coronary arteries) was carried out on small pieces of myocardium operatively resected from the left ventricle on 11 patients with coarctation of the aorta. The patients were 4 to 20 years of age. Structural modifications were found in the small coronary arteries and arterioles. Two patterns of morphologic alterations were noted in these small resistance vessels. In the first pattern, seen in most of the children, the components of the arterial wall were still distinguishable, and well represented portions of smooth muscle layers were visualized together with muscle cells showing signs of degeneration and more or less widespread collagenous islets. The second pattern, seen in young adults, was characterized by a total collagenous transformation of the arterial wall. In contrast, the smaller microvessels (precapillary sphincter, metarterioles and capillaries) appeared free of pathologic change. It is postulated that the precapillary sphincters play a special protecting and regulating role in the coronary microcirculation in such cases with elevated coronary pressure. It is suggested that surgery should be performed at an early age to prevent further development of structural changes in the microvessels. The microcirculatory damage may contribute to the increased surgical mortality in patients with coarctation of the aorta operated on at a later age. These findings should trigger further research on the small coronary vessels in systemic hypertension.