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Chest Aug 1998Evaluate the use of mediastinoscopy in the surgical diagnosis and treatment of mediastinal cystic masses in adults.
STUDY OBJECTIVE
Evaluate the use of mediastinoscopy in the surgical diagnosis and treatment of mediastinal cystic masses in adults.
DESIGN
Case reports and literature review.
SETTING
Academic department of surgery.
PATIENTS
Three consecutive adults with mediastinal masses identified on plain radiographs and CT.
INTERVENTIONS
Operative mediastinoscopy.
MEASUREMENTS AND RESULTS
All patients were successfully treated with removal of cyst wall, establishment of diagnosis, and same-day hospital discharge.
CONCLUSIONS
Simple mediastinoscopic removal of mediastinal cysts offers the same potential for diagnosis and treatment as more conventional methods, with a potential for less morbid and more cost-effective care.
Topics: Adult; Endoscopy; Female; Follow-Up Studies; Humans; Length of Stay; Male; Mediastinal Cyst; Mediastinoscopy; Middle Aged; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 9726753
DOI: 10.1378/chest.114.2.614 -
Journal of Nuclear Medicine : Official... Nov 1997The uptake of 99mTc-tetrofosmin in enlarged lymph nodes, of the lung hilus, in the case of sarcoidosis Stage I (histopathologically confirmed by mediastinoscopic biopsy)...
The uptake of 99mTc-tetrofosmin in enlarged lymph nodes, of the lung hilus, in the case of sarcoidosis Stage I (histopathologically confirmed by mediastinoscopic biopsy) is demonstrated. On a routine chest radiograph of a 78-yr-old woman, hilar lymphadenopathy was first detected. In the following mammography, disseminated micro calcifications were found in the left breast and a 99mTc-tetrofosmin study was performed for detection of breast cancer. Scintigraphy using 99mTc-tetrofosmin showed clear uptake in the hilar lymph nodes, but not in the left breast. The 99mTc-tetrofosmin uptake in the hilar lymph nodes was due to sarcoidosis confirmed by histology. Therefore, 99mTc-tetrofosmin scintigraphy may be useful in patients with suspected sarcoidosis, especially in Stage I.
Topics: Aged; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Lymph Nodes; Mediastinum; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Sarcoidosis; Tomography, Emission-Computed, Single-Photon
PubMed: 9374356
DOI: No ID Found -
Canadian Journal of Surgery. Journal... Oct 1996To determine if saphenous vein required for coronary bypass could be quickly, easily and safely removed with a minimally invasive technique.
OBJECTIVE
To determine if saphenous vein required for coronary bypass could be quickly, easily and safely removed with a minimally invasive technique.
DESIGN
A consecutive series.
SETTING
A university centre.
MATERIAL AND METHODS
In cadavers, a standard mediastinoscope was used to remove segments of the greater saphenous vein. Thigh segments, superior leg segments and ankle segments were removed. Fifteen minutes were allowed for removal of a segment.
RESULTS
Segments of vein 15 to 17 cm long could be removed. One segment could not be removed within 15 minutes. Thigh segments were easy to remove, calf segments were the most difficult. There were no avulsed side branches. All incisions were less than 5 cm long.
CONCLUSIONS
Saphenous vein can be harvested quickly and safely by a minimally invasive method. Lower extremity complications may be reduced and long-term patency improved with this in-situ technique of vein removal.
Topics: Cadaver; Coronary Artery Bypass; Endoscopy; Humans; Minimally Invasive Surgical Procedures; Saphenous Vein
PubMed: 8857986
DOI: No ID Found -
The Journal of Thoracic and... Aug 1994The significance of preoperative N factor assessment in T1 lung cancer and the need for mediastinal node dissection in T1 N0 M0 cases were investigated. The results of... (Comparative Study)
Comparative Study
The significance of preoperative N factor assessment in T1 lung cancer and the need for mediastinal node dissection in T1 N0 M0 cases were investigated. The results of mediastinoscopy were evaluated in patients with T1 adenocarcinoma or squamous cell carcinoma who underwent preoperative mediastinoscopy and thoracotomy from 1971 to 1991 (n = 164). Mediastinoscopy gave true negative results in 90% of patients, false negative in 1%, and true positive in 9%. The 5-year survival was 90% for patients with T1 N0 M0 disease who underwent nonradical dissection (n = 64) and 70% for those who underwent radical dissection (n = 61), indicating that the prognosis was significantly better (p < 0.05) with nonradical dissection. Distant metastasis was a common cause of death, and no death was related to local recurrence, whether nonradical or radical dissection had been performed. The results strongly suggest that preoperative mediastinoscopy and intraoperative node sampling are sufficient for assessment of N factors in T1 lung cancer. The possible relation between immunologic functional changes associated with mediastinal lymph node dissection and the prognosis in patients without evidence of positive lymph nodes should be clarified by a prospective randomized study.
Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mediastinoscopy; Mediastinum; Neoplasm Staging; Predictive Value of Tests; Preoperative Care; Prognosis; Retrospective Studies; Sensitivity and Specificity; Survival Rate
PubMed: 8041180
DOI: No ID Found -
Cancer Sep 2008Excision repair cross-complementation Group 1 (ERCC1) overexpression is associated with resistance to cisplatin-based chemotherapy in patients with nonsmall-cell lung...
BACKGROUND
Excision repair cross-complementation Group 1 (ERCC1) overexpression is associated with resistance to cisplatin-based chemotherapy in patients with nonsmall-cell lung cancer (NSCLC). A preliminary study also suggested that ERCC1 expression is associated with radioresistance in lung cancer cells. The aim of this study was to evaluate the clinical implications of ERCC1 expression in stage IIIA N2-positive NSCLC patients treated with platinum-based neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery.
METHODS
Sixty-eight patients with mediastinoscopy-proven N2-positive NSCLC were enrolled between August 1997 and September 2003. ERCC1 expression was assessed by immunohistochemistry from pretreatment mediastinoscopic biopsy specimens.
RESULTS
ERCC1 expression was positive in 31 of 68 specimens (46%). Among 14 patients who obtained pathologic complete response, 6 were positive for ERCC1 expression and 8 were negative (P = .818). On univariate analysis, with median follow-up of 61.8 months (range, 34.3-108.8 months), progression-free survival was 15.9 months for ERCC1-positive and 29.5 months for ERCC1-negative patients (P = .062), and there was a statistically significant difference in overall survival between ERCC1-negative tumors and ERCC1-positive tumors (89.2 vs 26.0 months, P = .014). On multivariate analysis, ERCC1 negativity (P = .041) and achieving mediastinal nodal clearance (downstage to pathological N0 or N1) after neoadjuvant CCRT followed by surgery (P = .005) were significant independent prognostic factors for the prolongation of survival.
CONCLUSIONS
These results suggest that N2-positive NSCLC patients with ERCC1 negative tumors show a survival benefit from neoadjuvant CCRT with a platinum-containing regimen.
Topics: Adenocarcinoma; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Carcinoma, Non-Small-Cell Lung; Chemotherapy, Adjuvant; Cisplatin; Combined Modality Therapy; DNA-Binding Proteins; Disease-Free Survival; Docetaxel; Endonucleases; Etoposide; Female; Humans; Immunoenzyme Techniques; Lung Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Paclitaxel; Survival Rate; Taxoids; Treatment Outcome
PubMed: 18623378
DOI: 10.1002/cncr.23693 -
Journal of Thoracic Disease May 2018
Three-port mediastino-laparoscopic esophagectomy (TPMLE) for an 81-year-old female with early-staged esophageal cancer: a case report of combining single-port mediastinoscopic esophagectomy and reduced port laparoscopic surgery.
PubMed: 29997998
DOI: 10.21037/jtd.2018.05.52 -
Acta Medica Okayama Dec 2011Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented...
Mediastinal lymph node carcinoma of unknown primary site is rare and may have a better prognosis if extensive treatment is performed. Case, A 69-year-old-male presented with a persistent cough. Chest computed tomography (CT) demonstrated a large tumor 9.5 × 8.2 cm, in the mediastinum, compressing the right main bronchus, the right pulmonary artery, and the superior vena cava. Because fiberoptic bronchoscopy was insufficient for diagnosis, mediastinoscopic tumor biopsy under general anesthesia was undertaken. Histological examination revealed adenocarcinoma. Extensive examinations revealed no other neoplastic lesion except in the mediastinum. Mediastinal lymph node carcinoma of unknown primary site was diagnosed. The patient was treated with docetaxel and cisplatin with concurrent thoracic radiation therapy. A month after the start of chemoradiotherapy, the mediastinal tumor regressed markedly. The patient remained free of symptoms without regrowth of the primary site. Exploration of the body showed no further abnormalities 20 months after disease onset.
Topics: Aged; Antineoplastic Agents; Carcinoma; Chemoradiotherapy; Cisplatin; Docetaxel; Humans; Lymph Nodes; Male; Mediastinal Neoplasms; Mediastinum; Neoplasms, Unknown Primary; Taxoids; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 22189482
DOI: 10.18926/AMO/47267 -
International Journal of Clinical and... 2014Accurate lymph nodal staging of lung cancer is critical for determining the treatment options. With the help of (18)F-fluorodeoxyglucose positron emission...
Accurate lymph nodal staging of lung cancer is critical for determining the treatment options. With the help of (18)F-fluorodeoxyglucose positron emission tomography/computer tomography ((18)F-FDG-PET/CT), the clinician can rule out/in the regional lymph nodes positive for metastasis in the patients with lung cancer in a majority of cases. However, a small proportion of cases with false positivity of metastasis have been reported. Transbronchial needle aspirations and mediastinoscopic biopsies are still necessary to determine whether enlarged hypermetabolic mediastinal lymph nodes are positive for lung cancer metastasis. Here we report three intricate cases showing hypermetabolic activity in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer on PET/CT. The first patient had squamous cell carcinoma in the left upper lobe of the lung with surrounding necrotizing granulomas and concurrent with silicosis and granulomatous inflammation in the lymph nodes; the second presented with symptoms of viral pneumonia, which was pathologically diagnosed as a lung adenocarcinoma, stage IA, concurrent with sarcoidosis involving the lymph nodes; the last case was diagnosed as squamous cell carcinoma in the right upper lobe of the lung, but lymph nodes showed reactive hyperplasia. These cases suggest that some cases are so complex that avid (18)F-FDG uptake in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer should be carefully analyzed based on individual patients' clinical background.
Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed
PubMed: 25550877
DOI: No ID Found -
The Thoracic and Cardiovascular Surgeon... Dec 2013The main prerequisite for the unimpaired wound healing after resection of tracheal stenosis is its tension-free end-to-end anastomosis. This is only achievable when the...
The main prerequisite for the unimpaired wound healing after resection of tracheal stenosis is its tension-free end-to-end anastomosis. This is only achievable when the tracheal ends can be adequately mobilized. Several mobilization techniques have been described in the literature. Here, the authors describe a case of tracheal mobilization under video mediastinoscopic assistance that displayed a considerable advantage over blunt mobilization and a length gain of over 3 cm.
PubMed: 25360409
DOI: 10.1055/s-0033-1350104 -
Bulletin Du Cancer Sep 2004Aim of this study was to define the optimal schedule of gemcitabine (GCB)\cisplatin (CDDP) combination as induction chemotherapy (CHT) in patients with stage IIIa... (Clinical Trial)
Clinical Trial
Optimization of the schedule of gemcitabine-cisplatin combination as induction regimen for patients with biopsy-proven stage IIIa N2 - stage IIIb non-small-cell lung cancer: a prospective phase-II study.
Aim of this study was to define the optimal schedule of gemcitabine (GCB)\cisplatin (CDDP) combination as induction chemotherapy (CHT) in patients with stage IIIa pN2-IIIb non - small-cell lung cancer (NSCLC). Fifty patients with mediastinoscopically-proven stage-IIIa pN2 -IIIb NSCLC were treated with 3 cycles of induction CHT followed by surgery (if staged IIIa) and three-time-daily accelerated radiotherapy. Chemotherapy initially consisted of 3 courses of CDDP 100 mg\m(2) d1 plus GCB 1000 mg\m(2) dd 1,8,15 repeated every 4 weeks, than was modified in CDDP 80 mg\m(2) d1 plus GCB 1250 mg\m(2) dd 1,8 repeated every 3 weeks. Twenty-nine four-week scheduled treatment cycles were firstly administered to 10 patients (pts): treatment-related toxicity, mainly hematological, caused a dose-reduction or treatment omission on day 15 in 65% of cycles. After the protocol was amended, 119 three-week scheduled treatment cycles were administered to 40 pts. Treatment-related toxicity of the new schedule caused a dose-reduction or treatment omission in only 10% of cycles, no patients requiring chemotherapy discontinuation. Thirty-seven out of fifty patients (74%, 95% CI: 60-85%) achieved a partial response, 7 had stable disease and 6 had disease progression. Similar activity was seen with both schedules. One nodal pathological complete remission was observed among the 24 pts who underwent surgery. At present, with a median follow-up of 13 months (mos), 2-year (y) survival of all the 50 pts and of the 24 pts staged IIIa who underwent surgery is estimated as 37% (95% CI: 24-58%) and 47% (95%CI: 27-80%), respectively. When given as induction chemotherapy, a three-week schedule of CDDP plus GCB combination appeared to be effective, with lower toxicity and better compliance than a four-week schedule.
Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung; Cisplatin; Deoxycytidine; Drug Administration Schedule; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prospective Studies; Remission Induction; Survival Analysis; Gemcitabine
PubMed: 15582897
DOI: No ID Found