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PubMed2006

Reconstruction of the chestwall and thorax.

Chest wall reconstructions can be complex and challenging procedures and may require a multidisciplinary approach. The most common indications for chest wall reconstruction are the repair of defects due to tumor ablation, infection, radiation necrosis, congenital deformities, and trauma. Flap reconstruction by plastic surgery is often required when skin is removed as part of the chest wall resection or when radiation therapy is given pre- or post-operatively. Tissue flaps may be needed to provide vascularized tissue over alloplastic materials used to stabilize the chest wall, to cover vital structures of the chest cavity, to fill dead space, and to improve cosmesis.

Female↗
PubMed1980

Indomethacin and ascorbate inhibit desmoid tumors.

Administration of indomethacin caused complete resolution of a desmoid tumor after a partial response to radiation. In another patient, this drug caused an immediate response, then became ineffective. When large doses of ascorbic acid were given with indomethacin, slow resolution of the tumor began and has continued for 14 months. Treatment of a third case with indomethacin and ascorbic acid from the beginning produced shrinkage of the tumor which has continued to date.

Abdominal Neoplasms↗
PubMed1983

Pancoast syndrome caused by extramedullary plasmacytoma.

A 61-year-old patient had the clinical findings of Pancoast syndrome with shoulder pain, weakness and atrophy of band muscles, and an opacified area in the apical lung field. Unlike most cases with Pancoast syndrome in which the tumors are primary carcinomas of the lung, the present case was shown to have a plasmacytoma involving the apical parietal pleura and the adjacent chest wall. The need for histologic diagnosis before treating patients with Pancoast syndrome is emphasized.

Humans↗
PubMed1990

Intralesional cis-diamminedichloroplatinum and purified collagen treatment of human metastatic malignancies: a feasibility study.

A feasibility study of the treatment of advanced superficial human malignant tumors utilizing direct intralesional injections of cisplatin mixed with purified bovine collagen was performed. The purpose of using intralesional injection of cisplatin mixed with collagen was to limit the drug exposure to normal tissues while increasing the dose and duration of exposure to the tumor. Fourteen evaluable superficial tumors in four patients (melanoma, breast CA, squamous CA from larynx) received a total of 65 treatments in the outpatient clinic setting. All patients had failed prior treatment with systemic intravenous cisplatin. Lesions were treated at least three times at two-week intervals. After intramuscular meperidine premedication, multiple injections of cisplatin mixed with collagen were made into the tumors. There was minimal normal tissue toxicity and minimal systemic toxicity. Tumor regression or stabilization occurred in 86% (12/14) of tumors; 50% (7/14) of lesions regressed more than 50% in size. This study suggests that intralesional colloidal cisplatin can overcome resistance to systemic intravenous cisplatin.

Adenocarcinoma↗
PubMed1994

Reconstruction of chest wall defects following extirpative surgery.

Reconstructive procedures following chest wall resection pose a special surgical challenge. With modern surgical technique, a wide range of reconstructive options are at the surgeon's disposal and, hence it is imperative that the appropriate procedure be selected in a given patient. A total of 64 patients underwent resection of malignant chest wall tumors at the Tata Memorial Hospital. The technique of preference at our institution for reconstruction of full-thickness chest wall defects uses a combination of autogenous fascia lata and Marlex mesh. We present our experience with chest wall reconstruction following extirpative surgery in these patients.

Fascia Lata↗
PubMed1984

Localized sarcoma of the chest wall.

This 9-year-old white male suffered mild trauma to the left side of the chest on two occasions in April 1981, and then developed a low-grade fever. A chest x-ray film showed pneumonia. He was then given oral ampicillin for 2 weeks, and the fever and left chest pain resolved. Repeat chest radiograph one month later showed a persistent density, and a bone scan revealed increased uptake in the left fifth rib. Osteomyelitis was diagnosed, and intravenous antibiotics were administered. In June 1981, the density had become larger on radiographic examinations, and a left chest wall mass was noted for the first time. He was referred to the Children's Hospital of Philadelphia, with the suspected diagnosis of Ewing's sarcoma of the left fifth rib. On arrival at the Children's Hospital of Philadelphia on June 13, 1981, the physical examination was unremarkable except for a 1 X 2-cm mass overlying the fifth rib anterolaterally. Dr Hugh Watts of the Division of Orthopedic Surgery reviewed the radiographs and bone scan and felt that the appearance was not consistent with primary Ewing's sarcoma of the rib. The boy was then taken to surgery by Dr. Moritz Ziegler on June 23, 1981, at which time biopsy of the lesion was accomplished. The tumor had by then grown to a size of 3 X 5 cm.

Child↗
PubMed1985

Serum neuron-specific enolase in metastatic Merkel cell tumors.

Three patients with widely disseminated Merkel cell tumors of the skin are presented. In all three cases, neuron-specific enolase (NSE) was demonstrated in neoplastic tissue by immunohistochemical staining, and serum NSE levels were also elevated in all three patients. Serum NSE may prove to be a useful tumor marker in this and other malignancies of neuroendocrine origin.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma study group (COSS).

The case histories of all patients with osteosarcoma of the trunk entered into the consecutive studies COSS 80 through COSS 86 of the Cooperative German/Austrian Osteosarcoma Study Group (COSS) were analyzed in order to evaluate their clinical characteristics and the impact of modern neoadjuvant therapy on prognosis. They were compared to those of all patients with extremity osteosarcoma treated according to the same protocols. While tumors of the trunk comprised only 32 (4.8%) of 665 primary classical osteosarcomas, secondary osteosarcomas were much more likely to be located in bones of the axial skeleton (6 of 18, 33%). Patients with primary osteosarcoma of the axial skeleton were older (mean: 20.8 vs. 15.2 years, P < 0.01) and were more likely to present with metastases at diagnosis (34% vs 12%, P < 0.001) than those with primary extremity osteosarcoma. In contrast to extremity tumors, local surgical treatment failure was very common in osteosarcomas of the trunk. Complete tumor removal was achieved in less than half of all evaluable cases. The prognosis of eight patients with localized primary axial osteosarcoma and effective surgical local control was not inferior to that of 483 equally evaluable patients with extremity tumors. In conclusion, while secondary systemic spread of axial osteosarcoma may be avoided in patients treated with multiagent chemotherapy, successful treatment is often barred by primary metastatic disease and inability to control the local tumor site.

Adolescent↗
PubMedDate not supplied

Anesthesia considerations for pediatric cancer.

The multidisciplinary approach to the care of children with cancer demands an understanding of all aspects of its treatment. Recognition of potential anatomic and physiologic derangements which may result from specific types of malignancy allows optimal preoperative preparation. Understanding the anesthetic implications of cancer chemotherapy, irradiation and surgery, and the medical complications which result, is essential. The anesthesiologist is involved in critical perioperative issues during surgical resection in the operating room, but just as importantly plays a crucial role in a variety of procedures performed in remote locations. An awareness of special problems related to cancer and its treatment allows optimal anesthesia care while dealing with such issues as radical surgery, organ system failure, acute and chronic pain, and terminal illness.

Abdominal Neoplasms↗
PubMed1998

The importance of fiber biopersistence and lung dose in determining the chronic inhalation effects of X607, RCF1, and chrysotile asbestos in rats.

The chronic inhalation effects in rats of X607 (a rapidly dissolving synthetic vitreous fiber) were compared with those previously reported for RCF1 (a refractory ceramic synthetic vitreous fiber) and chrysotile asbestos. Of primary concern was the importance of biopersistence as a mechanism of fiber toxicity. Fischer rats were exposed to fiber aerosol by nose-only inhalation for 6 h/day, 5 days/week for 2 years. X607 and RCF1 aerosols were similar in concentration (approximately 200 fibers/cc) and average dimensions (approximately 20 x 1 microns). Chrysotile aerosol was higher in concentration (10,600 fibers/cc) and an order of magnitude smaller in average dimensions. Lung fiber deposition after 6 h inhalation was greater for X607 than for RCF1. However, at later time points, fibers/lung (especially long fibers) were much lower for X607 than for RCF1, suggesting less biopersistence for X607. X607 was neither fibrogenic nor tumorigenic and induced only minimal lung cellularity that reversed after exposure was terminated. In contrast, RCF1 and chrysotile asbestos induced pulmonary fibrosis and thoracic neoplasms (chrysotile induced 32% more pulmonary neoplasms than RCF1). Lung deposition and fiber lengths did not explain the toxicologic differences between the three fibers. Fiber biodurability, including chemical and physical parameters, appears to be a major toxicologic determinant here. Chemical analysis of lung fibers revealed rapid leaching of X607 compared to RCF1. In in vitro dissolution tests, X607 underwent rapid dissolution (kdis = 990 ng/cm2/h) and transverse fragmentation, RCF1 dissolved slowly (kdis = 6 ng/cm2/h) and did not fragment, and chrysotile dissolution was negligible (< 0.1 ng/cm2/h).

Animals↗
PubMed1991

Case report of metastatic familial pheochromocytoma treated with cisplatin and 5-fluorouracil.

We report on a rare case of malignant pheochromocytoma in a patient with a family history of this disease. After three cycles of treatment with cisplatin and 5-fluorouracil, a decrease in the need for antihypertensive treatment occurred, which lasted almost 2 years despite the discontinuation of chemotherapy. The patient showed an objective response, which was technically a minor response, although in this slow-growing tumor it was of major clinical significance. This chemotherapy regimen may play a role in the management of malignant pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1988

An ultrastructural study of the morphology and lectin-binding properties of human mast cell granules.

The morphological characteristics and lectin-binding properties of mast cell granules from four human neurofibromata are described. Ultrastructural examination of the granules revealed that some contained dense cores, others had membranous configurations and some forms were intermediate between the two. A round electron-lucent area was present in some granules. After treatment with biotinylated lectins (10 micrograms ml-1) followed by an avidin-peroxidase revealing system (5 micrograms ml-1 in 0.125 M Tris-buffered saline with 0.347 M NaCl, pH 7.6), mast cell granules strongly bound Concanavalin A, garden pea, lentil, wheatgerm, erythro- and leuco-kidney bean lectins. This indicated the presence of abundant N-linked complex-type saccharide sequences. Soybean and peanut lectins showed only weak binding, while the presence of sparse alpha-L-fucosyl terminals was indicated by the weak binding of winged pea lectin. The staining intensity of wheatgerm lectin was considerably reduced when incubated in the presence of its specific competing sugar tri-N-acetylchitotriose. Despite a wide variety of morphological differences between granules, all showed similar staining patterns and all granules within a single cell shared the same binding characteristics.

Cytoplasmic Granules↗
PubMed1987

[Primary and secondary chest wall tumors--new imaging procedures].

For the diagnostic evaluation of chest wall tumours computed tomography, bone scintigraphy, sonography and magnetic resonance tomography as additional imaging methods are available. CT has the greatest clinical relevance; the most important advantage of CT is the exact topographic localization of the process and the evaluation of the soft tissue extension. A tumour specific diagnosis can only be expected on rare occasions. Bone scanning is the method of choice if destruction of the skeletal system is suspected.

Bone Neoplasms↗