Three patients with exogenous lipoid pneumonia are presented. All of them had laryngectomy because of the cancer of larynx. In a period of time ranging from a few months up to a few years after the operation they started to have dyspnoea, cough, sometimes hemoptysis and slightly elevated temperature. The chest X-ray revealed massive opacities in the lower zones of both lungs suggesting lung cancer or metastases of the laryngeal cancer. HRCT showed ground glass lesions. Histological examination of the lungs detected accumulation of multiple macrophages with vacuolated foamy cytoplasms in the alveoli. Neoplastic disease was excluded. Additional data from the patients history revealed that all of them were inhaling or administering mineral oil-containing products through the tracheostomy. Exogenous lipoid pneumonia was diagnosed. Patients were asked to stop inhalations with the mineral oil.
The aims: (1) comparison ofNSCLC stages according to bronchoscopic and radiological findings with pathological outcome (mediastinoscopy), (2) efficacy of the neoadjuvant ChT by means of nodal involvement and primary tumour (downstaging), (3) influence ofChT on the surgical procedures' extension and its morbidity Material and methods: I 00 consecutive patients with resectable NSCLC in stages 11B (13 pts) or IIIA (57 pts), who were qualified to neoadjuvant ChT, participated in this study (77 men and 23 women, aged 42–73). Tumour and lymph nodes (mediastinal and hilar) were measured in CT scan. Mediastinoscopy was performed in 70 pts (70%). Majority of patients (87%) received two cycles ofneoadjuvant ChT (cisplatin 80 mg/m2 iv on day 1 and vinorelbine 25 mg/m2 on day 1 and 5) administered every 21 days. After ChT 85 patients were qualified to surgery. The results: The metastases in mediastinoscopy were excluded in 32 out of 45 patients (71%), whose lymph nodes were enlarged in CT scan (radiological false positive). Metastases were confirmed in 4 out of 25 patients (16%), whose lymph nodes were normal in CT scan (radiological false negative). After ChT the regression of the disease (PR+CR) was noted in 37% of patients. Pneumonectomy was performed in 23 (27%) pts, bilobectomy in 11 (13%) pts, lobectomy in 39 (46%) pts and “extended” (sleeve) lobectomy in 12 (14%) pts. Resected material was examined microscopically very exactly in patients, in whom mediastinoscopy was performed before treatment. Downstaging was confirmed in 6 out of 15 patients (40%). Conclusions: Neoadjuvant ChT was effective in 37% of patients and allowed us to perform less exten sive surgery in these patients. 22 (64.7%) out of 34 patients who responded to ChT underwent lobecto my. Only 17 (36%) out of 51 patients who did not respond to ChT had lobectomy performed. Generally, 85 pts were operated with postroperative complications in 22.3% patients and 2.3% mortality rate.
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