Recurrent chest infections in two young non-smoker men

Pulmonary mucinous cystic carcinomas are rare salivary gland type carcinomas of the lung. They form part of a wide spectrum of mucin secreting glandular mixed type tumours. They comprise 0.1 – 0.2% of all lung tumours. They occur more frequently in young patients and present with cough or recurrent chest infections and therefore may be easily misdiagnosed. Since treatment depends fully on complete surgical resection early diagnosis is essential. Even with treatment the 10-year survival is quoted at 53%. We describe two cases of such rare tumours both of who underwent curative surgical resection. Both patients were younger than 35 years old and presented with recurrent chest infections. The patients were followed for up to eight years and the outcome recorded. A literature search confirms the occurrence in younger patients, who often present with pneumonias and that surgery is the only hope for cure.peer-reviewe

Long-term survival after an aggressive surgical resection and chemotherapy for stage IV pulmonary giant cell carcinoma

BACKGROUND: Pulmonary giant cell carcinoma is one of the rare histological subtypes with pleomorphic, sarcomatoid or sarcomatous elements. The prognosis of patients with this tumor tends to be poor, because surgery, irradiation and chemotherapy are not usually effective. CASE PRESENTATION: We herein report a patient with pulmonary giant cell carcinoma with stage IV disease in whom aggressive multi-modality therapy resulted in a long-term survival. A 51-year-old male underwent an emergent operation with a partial resection of small intestinal metastases due to bleeding from the tumor. The patient also underwent a left pneumonectomy due to hemothorax as a result of the rapid growth of the primary tumor. Thereafter, two different regimens of chemotherapy and a partial resection for other site of small intestinal metastases and a splenectomy for splenic metastases were performed. The patient is presently doing well without any evidence of recurrence for 3 years after the initial operation. CONCLUSION: This is a first report of a rare case with stage IV pulmonary giant cell carcinoma who has survived long-term after undergoing aggressive surgical treatment and chemotherapy

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for patients with peritoneal metastases from endometrial cancer

Background: More information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: This study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome. Results: A total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor. Conclusions: For selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma

Results of Pulmonary Resection: Sarcoma and Germ Cell Tumors

Pulmonary metastasis can be present in as frequently as 88% and 80%, respectively, of patients with sarcoma and germ cell tumour with metastatic disease. In both sarcoma and germ cell tumour, pulmonary metastatectomy may be the only means of rendering a patient disease-free. Sublobar (wedge or segmentectomy), lobectomy, and, rarely, pneumonectomy can be safely performed to achieve complete resection. Bilateral disease can be resected via staged thoracoscopy/thoracotomy, median sternotomy, or clamshell thoracotomy. Finally, multiple resections and re-resections in select patients have resulted in improved survival. The main principle of pulmonary metastatectomy is complete resection. In the appropriately selected patient 5-yr survival rates of as high as 35-52% for sarcoma, and 80% for germ cell tumour can be realized

Management of germ cell tumors in children: Approaches to cure

The introduction of cisplatinum chemotherapy and current advances in the surgical treatment have resulted in a dramatic improvement of the prognosis of children with malignant germ cell tumors (GCT). Cisplatinum chemotherapy generally results in sufficient systemic tumor control, but local relapses may still occur in patients who did not receive adequate local treatment. Therefore, the therapeutic consideration must take into account age, primary site of the tumor, and its histology. In gonadal tumors, there is a high chance of primary complete resection since these tumors tend to be encapsulated, and particularly testicular GCT are often detected at a low tumor stage. In contrast, a primary complete resection may be impossible in large nongonadal tumors such as sacrococcygeal or mediastinal GCT. In these tumors, a neoadjuvant or pre-operative chemotherapy after clinical diagnosis by imaging and evaluation of tumor markers significantly facilitates complete resection on delayed surgery. In addition, the impact of chemotherapy on local tumor control may be enhanced by locoregional hyperthermia. In most intracranial GCT complete resection is impossible and may be associated with significant morbidity. Nevertheless, biopsy is essential for diagnosis in nonsecreting tumors. In intracranial GCT, radiotherapy significantly contributes to local tumor control, and doses are stratified according to histology. These general considerations have been integrated into national and international cooperative treatment protocols. In most current protocols, treatment is stratified according to an initial risk assessment that includes the parameters age, site, histology, stage, completeness of resection and the tumor markers alpha(1)-fetoprotein (AFP) and human choriogonadotropin (beta-HCG). With such modern protocols overall cure rates above 80% can be achieved. Moreover, the previously high-risk groups may now expect a favorable prognosis with this risk-adapted treatment, whereas an increasing number of low-risk patients are treated expectantly or with significantly reduced chemotherapy. As current biologic studies reveal distinct genetic patterns in childhood GCT, it can be expected that further combined clinical and genetic studies will be valuable for risk assessment of childhood GCT

Statistical atlas based registration and planning for ablating bone tumors in minimally invasive interventions

Bone tumor ablation has been a viable treatment in a minimally invasive way compared with surgical resections. In this paper, two key challenges in the computer-Assisted bone tumor ablation have been addressed: 1) establishing the spatial transformation of patient's tumor with respect to a global map of the patient using a minimum number of intra-operative images and 2) optimal treatment planning for large tumors. Statistical atlas is employed to construct the global reference map. The atlas is deformably registered to a pair of intra-operative fluoroscopy images, constructing a patient-specific model, in order to reduce the radiation exposure to the sensitive patients such as pregnant and infants. The optimal treatment planning system incorporates clinical constraints on ablations and trajectories using a multiple objective optimization, which obtains optimal trajectory planning and ablation coverage using integer programming. The proposed system is presented and validated by experiments. © 2012 IEEE.published_or_final_versio

The Effects of Reduction Mammaplasty

Symptomatic hypertrophic breasts cause a health burden with physical and psychosocial morbidity. The value of reduction mammaplasty in the treatment of symptomatic breast hypertrophy has been consistently reported by patients and has been well recognised by plastic surgeons for a long time. However, the scientific evidence of the effects of reduction mammaplasty has been weak or lacking. During the design of this study most of the previous studies were retrospective and the few prospective studies had methodological limitations. Therefore, an obvious need for prospective randomised studies was present. Nevertheless, practical and ethical considerations seemed to make this study design impossible, because the waiting time for the operation was several years. The legislation and subsequent introduction of the uniform criteria for access to non-emergency treatment in Finland removed these obstacles, as all patients received their treatment within a reasonable time. As a result, a randomised controlled trial with a six-month follow-up time was designed and conducted. In addition, a follow-up study with two to five years follow-up was also carried out later. The effects of reduction mammaplasty on the patients breast-related symptoms, psychological symptoms, pain and quality of life was assessed. In addition, factors affecting the outcome were investigated. This study was carried out in the Hospital District of Helsinki and Uusimaa, Finland. Eighty-two out of the approximately 300 patients on the waiting list in 2004 agreed to participate in the study. Patients were randomised either to be operated (40 patients) on or to be followed up (42 patients). The follow-up time for both groups was six months. The patients were operated on by plastic surgeons or trainees at the Department of Plastic Surgery at Helsinki University Central Hospital or at the Department of Surgery at Hyvinkää Hospital. The patients completed five questionnaires: the SF-36 and the 15D quality of life questionnaires, the Finnish Breast-Associated Symptoms questionnaire (FBAS), a mood questionnaire (Raitasalo s modification of the short form of the Beck Depression Inventory, RBDI), and a pain questionnaire (The Finnish Pain Questionnaire, FPQ). Sixty-two out of the original 82 patients agreed to participate in the prospective follow-up study. In this study, patients completed the 15D quality of life questionnaire, the Finnish Breast-Associated Symptoms questionnaire, and the RBDI mood questionnaire. After six months follow-up, patients who had undergone reduction mammaplasty had a significantly better quality of life, fewer breast-associated symptoms and less pain, and they were less depressed or anxious when compared to patients who had not undergone surgery. The change in quality of life was more than two times the minimal clinically important difference. The patients preoperative quality of life was significantly inferior when compared to the age-standardised general population. This health burden was removed with reduction mammaplasty. The health loss related to symptomatic breast hypertrophy was comparable to that of patients with major joint arthrosis. In terms of change in quality of life, the intervention effect of reduction mammaplasty was comparable to that of hip joint replacement and more pronounced than that of knee joint replacement surgery. The outcome of reduction mammaplasty was affected more by preoperative psychosocial factors than by changes in breast dimensions. The effects of reduction mammaplasty remained stable at two to five years follow-up. In terms of quality of life, symptomatic breast hypertrophy causes a considerable health loss comparable to that of major joint arthrosis. Patients who undergo surgery have fewer breast-associated symptoms and less pain, and they are less depressed or anxious and have an improved quality of life. The intervention effect is comparable to that of major joint replacement surgery, and it remains stable at two to five years follow-up. The outcome of reduction mammaplasty is affected by preoperative psychosocial factors.Ylisuuret ja painavat rinnat voivat monin tavoin vaikuttaa heikentävästi naisen terveydentilaan. Ylisuurten rintojen koko ja paino aiheuttaa niskahartiaseudun oireistoa, päänsärkyä ja selkäkipua sekä hankaloittaa tavallista liikkumista tai liikunnan harrastamista. Rintojen alainen iho voi hautua rikki ja rintaliivien olkaimista painua kivuliaat urat hartioihin. Sopivien ja riittävästi tukevien rintaliivien löytäminen on hankalaa. Usein pitkään jatkuneeseen kipuoireistoon liittyy huomattavaa psyykkistä rasitetta kuten masennusta, ahdistusta ja itsetunnon alentumaa. Ylisuuret rinnat voivat aiheuttaa myös hankaluuksia ja esteitä sosiaalisessa ja intiimissä kanssakäymisessä. Kokonaisuutena elämänlaatua heikentävä vaikutus on huomattava. Vuoteen 2005 mennessä oli julkaistu muutamia laadukkaita eteneviä tutkimuksia rintojen pienennysleikkauksen vaikuttavuudesta. Satunnaistettu tutkimus on kuitenkin luotettavin tapa osoittaa hoidon vaikuttavuutta eikä tällaisia ollut löydettävissä. Tutkimuksen tarkoituksena oli selvittää rintojen pienennysleikkauksen vaikuttavuutta satunnaistetulla tutkimusasetelmalla. Potilaat satunnaistettiin leikattaviin potilaisiin, jotka kontrolloitiin 6 kuukautta leikkauksesta ja ei-leikattaviin potilaisiin, jotka kontrolloitiin 6 kuukautta seuranta-ajan jälkeen. Näitä kahta ryhmää verrattiin toisiinsa arvioitaessa leikkauksen vaikuttavuutta. Jälkimmäisen ryhmän (ei-leikattavat) potilaat leikattiin normaaliin tapaan tutkimuksen seuranta-ajan jälkeen. Vaikuttavuutta arvioitiin kartoittamalla potilaiden yleistä elämänlaatua, rintoihin liittyviä oireita, mielialaa ja kipua. Tämän tutkimuksen rintojen pienennysleikkausta odottavien potilaiden elämänlaadun alenemaa verrattiin myös aikaisempien tutkimusten polven tai lonkan tekonivelleikkausta odottaviin potilaisiin. Samoin leikkauksen elämänlaatua korjaavaa vaikutusta verrattiin polven ja lonkan tekonivelkirurgiaan. Lopuksi selvitettiin rintojen pienennysleikkauksen vaikuttavuuden pysyvyyttä 2-5 vuotta leikkauksesta. Tutkimuksessa todettiin, että ylisuurten rintojen aiheuttamaan haittaoireistoon liittyy merkittävästi heikentynyt elämänlaatu, kun sitä verrattiin ikävakioidusti yleiseen naisväestöön. Ylisuuriin rintoihin liittyvä potilaiden elämänlaadun heikkenemä on samaa suuruusluokkaa kuin tekonivelleikkausta odottavilla polvi- tai lonkkanivelkulumapotilailla (myös tässä vertailussa otettiin huomioon iän aiheuttama vaikutus elämänlaatuun). Rintojen pienennysleikkauksen voitiin kuuden kuukauden seurannan jälkeen todeta parantavan merkittävästi potilaiden elämänlaatua sekä vähentävän merkittävästi rintoihin liittyviä haittaoireita ja kipua. Yleisen elämänlaadun korjaantuma oli samaa luokkaa kuin tehtäessä lonkan tekonivelleikkaus ja suurempi kuin tehtäessä polven tekonivelleikkaus. Potilaiden ahdistus- ja masennusoireisto väheni myös merkittävästi rintojen pienennysleikkauksen jälkeen ja oireiston määrä voitiin luonnehtia samantasoiseksi kuin väestössä yleensä. Rintojen pienennysleikkauksen vaikuttavuuden voitiin todeta säilyvän 2-5 vuoden seurannassa, kun selvitettiin potilaiden elämänlaadun, mielialan ja rintoihin liittyvien haittaoireiden taso. Tulokset muutaman vuoden seurannassa osoittautuivat joiltakin osin jopa hivenen paremmiksi kuin lyhytaikaisen seurannan (kuusi kuukautta) tulokset, jolloin toipuminen ja täyden leikkauksesta saatavan hyödyn saavuttaminen saattaa olla vielä kesken. Tutkimuksen tulokset osoittavat, että naisilla, jotka hakeutuvat ylisuurten ja painavien rintojen pienennysleikkaukseen, on rasitteenaan huomattava terveydellinen haitta. Rintojen pienennysleikkauksella saadaan tähän merkittävä helpotus, joka säilyy seurannassa. Rintojen pienennysleikkauksen vaikuttavuus on myös verrattavissa muuhun yleisesti hyväksyttyyn kirurgiaan