Conclusions-These findings support the suggestion that MVD is a reliable prognostic marker in SCC of the oesophagus. Moreover, MCD may have a role in the angiogenesis of these tumours and might be responsible for their aggressive behaviour. (J Clin Pathol 2001;54:940-944)
We conclude that treatment of malignant esophageal obstructions, including esophagorespiratory fistulas, with SEMS is an alternative palliative procedure. Furthermore SEMS implantation seems more safe in the case of tumor stenoses locating in the middle esophagus.
We investigated the efficacy of transcutaneous electrical nerve stimulation (TENS) for postthoracotomy pain control in a prospective, randomized, double-blind, placebo-controlled study. We studied two groups of patients undergoing posterolateral thoracotomy. In group 1, TENS was used postoperatively on 60 patients for 5 days. Group 2 contained 56 patients without TENS. In both groups a visual analog scale (VAS) was used to indicate if analgesia was needed. When the VAS was higher than 4, an analgesic was administered. We observed the forced expiratory volume in 1 second (FEV(1)), the forced vital capacity (FVC), partial arterial oxygen pressure (PaO2), partial arterial carbon dioxide pressure (PaCO2), and how many doses of analgesia were given at postoperative 0 (extubation time), 2, 6, 12, 24, 48, 72, and 120 hours. TENS was not employed in patients with cardiac or neurologic disease. In group 1, TENS reduced the need to administer opioids during the 5-day postoperative period. This result is statistically significant (P = 0.013). Additionally, following the sixth postoperative hour, TENS increased the spirometric breath function. The FEV1, FVC, and PaO2 were high and PaCO2 was low when the first group is compared to the second. All these results are statistically significant (P = 0.012, P = 0.01, P = 0.024, and P = 0.02 respectively). We observed that TENS produced no evidence of side effects or intolerance in the patients of group 1. TENS is thus beneficial for pain relief following thoracotomy and has no side effects. Consequently, the routine use of TENS following thoracic surgery is recommended.
Background: Vasodilator stimulated phosphoprotein (VASP) is associated with focal adhesions and is thought to have an important role in actin filament assembly and cell motility. We hypothesise that an increase in the expression of VASP is involved in the progression and invasion of lung adenocarcinomas in parallel to tumour progression. A study was undertaken to analyse VASP expression in normal lung tissue and lung adenocarcinomas. Methods: Human lung tissues with adenocarcinomas (n = 26) were used. Normal lung tissue specimens (n = 14) were taken from areas a standard distance (3 cm) from resected adenocarcinomas of patients who underwent surgical lung resection. Adenocarcinomas were classified according to pathological staging and histopathological grades. Tissues were stained for VASP using immunohistochemistry. Results: Normal lung pneumocytes showed no VASP expression while alveolar macrophages had the strongest immunoreactivity for VASP. Bronchial epithelium (surface epithelium, goblet cells) and bronchial gland cells had a very weak immunoreactivity for VASP. Adenocarcinomas had significantly greater VASP expression than normal epithelium (p,0.001). Moreover, VASP expression in adenocarcinomas increased significantly with more advanced tumour stage (p,0.001). Conclusions:The spatial and differential expression of VASP in normal lung tissue and lung adenocarcinomas suggests that it is likely to be involved in the differentiation of normal lung cells to adenocarcinomas. The significant increase in the expression of VASP in adenocarcinomas in parallel to pathological staging suggests that it may regulate the invasive behaviour of lung adenocarcinomas as adenocarcinoma invasion is increased in more advanced tumours.
In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow-up results of the one-stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%) patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%) patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients, and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need for a second operation.
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