Search

BACKGROUND: The aim of this study was to determine the risk of overall death in long-term survivors (> 5 years) after pneumonectomy for non-small cell lung cancer (NSCLC), and to establish the optimal follow-up strategy for these patients. METHODS: We analyzed a single-center experience with 94 long-term survivors who underwent pneumonectomy (group A) for NSCLC between January 1992 and December 2000. Prospective tumor registry data were compared with data for 147 long-term survivors who underwent lobectomy (group B) during the same period. RESULTS: Clinical characteristics at the time of operation differed between the two groups with more squamous histology, larger tumor size, and more advanced stage in group A compared with group B. During follow-up, late lung cancer relapses were rare in both groups (2.1% vs 1.4%), and second primary malignancies were less frequent in group A (2.1% vs 9.5%, p = 0.032). The overall 10-year survival rate was lower in group A than in group B (67.3% vs 82.8%); however, there was no significant difference in lung cancer-specific survival (93.5% vs 95.1%). Intercurrent disease was the leading cause of death in group A (14 patients, 14.9%), most commonly respiratory failure resulting from community-acquired pneumonia. CONCLUSION: Late cancer relapse or second primary malignancies were rare in long-term survivors after pneumonectomy, but the overall mortality remained high as a result of intercurrent diseases. Continued surveillance should focus on prevention, early detection and aggressive management of intercurrent disease during follow-up care of these patients. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVES: Controversy has ensued about the prognostic relevance of the new World Health Organization (WHO) schema for the classification of thymoma. In this study, we present the clinical and histologic features of 108 thymomas and evaluate the usefulness of this histologic schema in view of the prognosis. DESIGN: Retrospective, clinicopathologic analysis of our experience and a review of recent literature. SETTING: Department of Thoracic and Cardiovascular Surgery of a university hospital. METHODS: A series of 108 thymomas were reviewed and classified by the new WHO schema. The clinical characteristics and the survival outcome were investigated in reference to the WHO subtypes. The Cox proportional hazards model was applied to determine the factors affecting the tumor-related survival. Recent literature on the prognostic relevance of the WHO schema was reviewed. RESULTS: There were 7 type A tumors, 25 type AB tumors, 12 type B1 tumors, 32 type B2 tumors, 20 type B3 tumors, and 12 type C tumors. The histologic subtype closely correlated with the Masaoka stage (p = 0.00). The tumor-related survivals at 5 years and 10 years were 88.0% and 77.9%, respectively. Stage III and IV tumors had a significantly worse prognosis than stage I or II tumors (p < 0.05). Type B3 tumors had an intermediate prognostic ranking in comparison with the carcinomas and with the other groups. On multivariate analysis, the WHO subtype (A-B2 vs B3 vs C) could predict the tumor-related survival, but the Masaoka stage was the most important prognostic factor affecting the postoperative survival (p = 0.026). CONCLUSION: The Masaoka stage is the most important determinant of survival in surgically resected cases of thymoma. To clarify the prognostic relevance and clinical usefulness of the WHO schema, consistent parameters reflecting the surgical outcome and development of the diagnostic tools that could improve the interobserver agreement within type B are needed. [ABSTRACT FROM AUTHOR]

Study Objectives: Eosinophilic bronchitis (EB) presents as a chronic cough and sputum eosinophilia without airflow limitation or bronchial hyperreactivity. Its long-term clinical course remains unknown. This study evaluated how frequently EB recurs and whether it develops chronic airway obstruction.Design: This study was a prospective analysis.Methods: Cough severity, FEV(1), provocative concentration of methacholine causing a 20% fall in FEV(1), and sputum eosinophil percentages were serially measured in 36 subjects for up to 48 months. All subjects inhaled corticosteroids until cough subsided.Results: Five of the twenty four follow-up subjects (21%) had a recurrent episode of EB 4 to 6 months after disappearance of the first episode of EB (recurrent eosinophilic bronchitis). Progressive FEV(1) reduction > 20% was observed in three of the subjects, including a subject with asthma developing at the ninth month. Nineteen subjects had no recurrence of cough (nonrecurrent eosinophilic bronchitis) and no progressive FEV(1) reduction > 20%. However, sputum eosinophilia recurred between 4 months and 24 months in 10 subjects. Mean values of FEV(1) at the ninth and 12th months of the study were significantly lower in the recurrent eosinophilic bronchitis group than in the nonrecurrent eosinophilic bronchitis group (p < 0.01).Conclusion: These results suggest that repeated episode of EB is associated with the development of chronic airflow obstruction, including asthma. [ABSTRACT FROM AUTHOR]

Background: NBS LabChip G2-3 is a novel, ultrafast, chip-type portable real-time polymerase chain reaction (PCR) system. We evaluated the clinical usefulness of this system in detecting pulmonary TB and assessed its diagnostic performance compared with a conventional tube-type PCR system., Methods: A total of 247 sputum samples were collected from patients suspected of having pulmonary TB. After the decontamination process, these samples were examined by fluorescence staining for acid-fast bacilli, cultures with both solid and liquid media, and real-time PCR with the NBS LabChip and a conventional tube-type system. The diagnostic accuracy of the NBS LabChip system and the agreement between the two assays were evaluated., Results: Considering mycobacterial culture results as a gold standard, the overall sensitivity and specificity of the NBS LabChip was 83.8% (95% CI, 73.8%-91.1%) and 94.0% (95% CI, 89.3%-97.1%), respectively. For the detection of TB from the smear-positive samples, the sensitivity and specificity of the NBS LabChip was 96.0% (95% CI, 86.3%-99.5%) and 83.3% (95% CI, 72.3%-95.7%), respectively. For the smear-negative samples, the sensitivity and specificity of the NBS LabChip was 63.3% (95% CI, 43.9%-80.1%) and 95.0% (95% CI, 90.4%-97.8%), respectively. There were no significant differences in the sensitivity and specificity between the NBS LabChip and a conventional tube-type system, although the NBS LabChip shortened the PCR time (27 min for 45 cycles)., Conclusions: The NBS LabChip G2-3 system has potential as an ultrafast, cost-effective diagnostic tool for pulmonary TB with high sensitivity and specificity.

Background: Morbidly obese individuals (ie, body mass index [BMI], > or = 40 kg/m2) may have a pulmonary gas exchange impairment due to the large fat mass surrounding their abdomen., Purposes: To examine the effect of the waist-to-hip (W/H) ratio on pulmonary gas exchange in the morbidly obese., Methods: Twenty-five morbidly obese individuals (mean [+/- SD] age, 39 +/- 10 years; mean BMI, 49 +/- 7 kg/m2; mean body fat, 50 +/- 6%; mean waist circumference, 135 +/- 15 cm; mean W/H ratio, 0.97 +/- 0.11) scheduled for bariatric surgery were recruited. Arterial blood was sampled in duplicate after 5 min of rest sitting upright., Results: The mean PaO2 at rest was 88 +/- 7 mm Hg (range, 72 to 108 mm Hg), the alveolar-arterial oxygen pressure difference (P[A-a]O2) was 19 +/- 9 mm Hg (range, 1 to 37 mm Hg), and the PacO2 was 38 +/- 3 mm Hg (range, 32 to 44 mm Hg). Linear regression showed that 32% and 36%, respectively, of the variance in the P(A-a)O2 and PaO2 were explained by the W/H ratio (p < 0.004 for both). As well, 20% of the variance in PacO2 was explained by the W/H ratio (p = 0.02). Men had larger W/H ratios (p < 0.01) and poorer gas exchange (p = 0.06) compared to women (mean difference: PaO2, -7 mm Hg; P[A-a]O2, 6 mm Hg)., Conclusion: Morbidly obese men showed a trend to have poorer pulmonary gas exchange compared to morbidly obese women, and a significant part of the blood gas status in these patients is associated with the W/H ratio.