Duration of knowledge in general thoracic surgery.

Background: Medical knowledge changes rapidly, so current medical education approaches emphasize the development of life-long learning skills ("teaching the learner to learn") as opposed to the simple acquisition of contemporary medical knowledge. Because there are no data on the rapidity of change of general thoracic surgical knowledge, we do not know whether this trend in medical education is appropriate for thoracic surgical trainees. We undertook a study to assess the duration of knowledge in general thoracic surgery.

Bronchogenic carcinoma in patients age 30 and younger.

Background: Lung cancer is rare in patients 30 years of age or younger. There is very little published data on lung cancer in this group of patients.

Methods: A retrospective review of patients 30 years of age and younger with bronchogenic carcinoma treated at Roswell Park Cancer Institute between 1973 and 1994 was done.

A 25-year thymoma treatment review.

Most thymomas are stage I or II at presentation, and they have a good prognosis with surgical treatment. Higher stage thymomas are less common and their treatment is more problematic. Our center tends to attract patients with higher stage thymomas for treatment.

Malignant pleural mesothelioma: a problematic review.

Malignant pleural mesothelioma is a rare tumor that has been difficult to study. Because of disappointing treatment results, malignant pleural mesothelioma has remained an area of active research and development. A clinicopathologic review is performed in light of several problematic issues involving diagnosis, staging, natural history, and treatment.

Bronchogenic carcinoma in young patients.

Background And Objectives: Some investigators have suggested that lung cancer in young patients has a more aggressive course and poorer prognosis than lung cancer in older patients.

Methods: A retrospective review is presented of patients less than 40 years of age with bronchogenic carcinoma treated at Roswell Park Cancer Institute between 1984 and 1994, with comparison to a cohort of patients treated in the previous decade.

Results: There were 76 patients (41 male and 35 female).

Primary tumors of the mediastinum.

Background And Objectives: Diagnostic and therapeutic approaches to mediastinal tumors have changed over the past three decades. We reviewed our recent experience with these tumors and assessed the role of a multidisciplinary treatment approach.

Methods: A retrospective review of 124 patients with primary mediastinal tumors over a 25-year period.

Metachronous benign solitary fibrous tumours of the pleura (localized "mesotheliomas"): a case report.

Solitary fibrous tumours are uncommon pleural tumours that are not related to mesotheliomas. They are typically benign and pedunculated and may grow to massive sizes. Surgical resection is usually curative.

Prognostic implications of pulmonary satellite nodules: are the 1997 staging revisions appropriate?

In the 1992 AJCC and 1993 UICC staging systems, primary lobe satellite nodules increased the T designation of the primary by one level and ipsilateral non-primary lobe satellite nodules raised the T designation to T4. The recent 1997 UICC and AJCC staging revisions assign a T4 (IIIb) designation to satellite nodules in a primary lobe, and a M1 (IV) designation to satellites in ipsilateral non-primary lobes. There is abundant evidence showing that satellite nodules are negative prognostic factors, but their inclusion in stage IIIb and IV may not be appropriate.

Operation and photodynamic therapy for pleural mesothelioma: 6-year follow-up.

Background: Conventional therapy for pleural mesothelioma has met with disappointing results.

Methods: From 1991 to 1996, 40 patients with malignant pleural mesothelioma were treated with surgical resection followed by immediate intracavitary photodynamic therapy.

Results: The series included 9 women and 31 men with a mean age of 60 years.

Ischemic conditioning (delay phenomenon) improves esophagogastric anastomotic wound healing in the rat.

Background And Objectives: Esophagogastric anastomotic leaks are a major source of morbidity after esophagectomy. Occult ischemia of the mobilized gastric fundus is an important etiological factor for this failure of healing. To test the hypothesis that ischemic conditioning (delay phenomenon) could improve esophagogastric anastomotic healing, anastomotic healing was studied in a rodent model of partial gastric devascularization.

Gastric distention exacerbates ischemia in a rodent model of partial gastric devascularization.

Occult ischemia of the mobilized gastric fundus is an important etiologic factor for esophagogastric anastomotic leaks after esophagectomy. Postoperative gastric distention is another possible predisposing factor for anastomotic leakage. We hypothesized that gastric distention could worsen gastric ischemia.

The effect of ischemic conditioning on gastric wound healing in the rat: implications for esophageal replacement with stomach.

Background: Esophagectomy, with gastric pull up replacement, is not uncommonly complicated by leakage from the esophagogastrostomy anastomosis. Occult ischemia of the mobilized gastric fundus is a major etiological factor for anastomotic leakage. Gastric tissue perfusion can be improved by ischemic conditioning ("delay" phenomenon).

Necrotizing soft tissue infections of the chest wall.

Background: Necrotizing soft tissue infections of the chest wall are uncommon, and they have received little discussion in the medical literature.

Methods: We performed a collective review of the literature to summarize information on etiology, prevention, treatment, complications, and outcome of chest wall necrotizing soft tissue infections. Manual, Medline, and Current Contents searches of the English-language medical literature were done.

Long-term outcome after pneumonectomy for nonsmall cell lung cancer.

Long-term survivors (5 or more years) of pneumonectomy for nonsmall cell lung cancer are at risk for late death from cancer recurrence, second primary malignancies, and cardiopulmonary insufficiency related to the adverse physiological effects of pneumonectomy. A retrospective study of pneumonectomy patients was done to quantify the risks of late death from these causes. Of 246 patients treated for nonsmall cell lung cancer by pneumonectomy, medical records of 49 who survived 5 or more years were reviewed.

Herpes simplex viral pneumonia in the postthoracotomy patient.

Over a 6-month period, 6 of 54 postthoracotomy patients developed pneumonia and respiratory failure. Pneumonia was secondary to herpes simplex virus type 1 in 3 of the 6 patients. Diagnostic efforts including bronchoscopy with bronchial washing, viral cultures, and cytologic examination permitted early diagnosis and successful treatment with acyclovir.

Operation and intracavitary photodynamic therapy for malignant pleural mesothelioma: a phase II study.

From April 1991 to May 1993, 23 patients entered a phase II clinical study of surgical resection and adjuvant intracavitary photodynamic therapy for malignant pleural mesothelioma. Two days preoperatively, patients received an intravenous injection of 2 mg/kg of the photosensitizer Photofrin. Six patients underwent a pleuro-pneumonectomy, and 15 patients a pleurectomy, after which intracavitary photodynamic therapy was administered.

Neurilemmoma of the diaphragm.

Diaphragmatic neurilemmomas are rare tumors. We report here such a case and also review five cases from the English-language medical literature. Neurilemmomas of the diaphragm are benign tumors that display slow, progressive growth.

[The importance of DNA analysis in the diagnosis of steroid 5-alpha-reductase deficiency].

The deficiency of steroid 5 alpha-reductase leads to the disturbances in sex differentiation that cause symptoms of male pseudohermaphroditism. The methods of DNA analysis used to diagnose mutations of steroid 5 alpha-reductase gene (SRD5A2) were presented and discussed. Within the group of 21 patients with the deficiency of steroid 5 alpha-reductase 2 described so far in literature, the analysis of SRD5A2 gene revealed two "major" deletions, one "minor" deletion, 16 point mutations (incl.

Acute renal failure following pulmonary surgery.

Objective: To determine incidence, predisposing factors, and outcome of acute renal failure complicating pulmonary surgery.

Design: Retrospective review.

Setting: Tertiary cancer hospital.

Pulmonary complications in patients undergoing thoracotomy for lung carcinoma.

One hundred three consecutive patients undergoing 106 thoracotomies for primary lung carcinoma were reviewed to determine factors associated with the development of postoperative pulmonary complications. Pulmonary complications occurred in 40 of 104 (39 percent) patients. Minor complications occurred in 17 of 104 (16 percent) patients and major in 23 of 104 (22 percent).

Ultrasonic surgical aspirator for lung resection.

The ultrasonic surgical aspirator was originally developed for neurosurgical procedures and hepatic resections. Ultrasonic vibration at the tip of the instrument results in lysis of the parenchymal cells, leaving more resistant fibrous tissue such as blood vessels and bronchi intact and, thus, minimizing blood loss. We have studied the feasibility of applying the ultrasonic surgical aspirator for segmental and subsegmental lung resection for primary and metastatic neoplasms of the lung.

Bronchogenic carcinoma in patients under age 40.

Eighty-nine patients aged 19 to 39 years were treated for bronchogenic carcinoma at Roswell Park Memorial Institute between 1973 and 1983. The male to female ratio was 1.6:1.