OBJECTIVE:The objective of this study was to determine the efficacy of alginate staple-line reinforcement of fissure openings as compared with stapling alone, with or without tissue sealant or glue, in reducing the incidence and duration of air leakage after pulmonary lobectomy for malignancy.SUMMARY BACKGROUND DATA:No randomized trial evaluating alginate staple-line reinforcement has been performed to date.METHODS:The Staple-line Reinforcement for Prevention of Pulmonary Air Leakage study was a multicenter randomized trial, with blinded evaluation of endpoints. Patients over 18 years of age scheduled for elective open lobectomy or bilobectomy for malignancy were eligible for enrollment. At thoracotomy, patients were deemed ineligible if an unanticipated pneumonectomy was indicated, or if air leakage occurred after the liberation of pleural adhesions. Otherwise, if the fissure was incomplete or the lung had an emphysematous appearance, patients were randomized to either standard management or interventional procedure consisting of fissure opening with linear cutting staplers buttressed with paired alginate sleeves (FOREseal). The number of eligible patients necessary in each randomization arm was estimated to be 190, and an outcomes analysis was performed on an intention-to-treat basis.RESULTS:Of the 611 patients consented to study enrollment, 380 met the inclusion criteria and were randomized. Based on an intention-to-treat analysis, the primary endpoint of air leak duration was not different between the 2 groups: 1 day (range: 0-2 d) in the FOREseal group and 1 day (range: 0-3 d) in the control group (P = 0.8357). In addition, the 2 groups were similar in terms of the proportion of patients presenting with prolonged air leakage (7.8% in the FOREseal group vs 11.3% in the control group, P = 0.264) and the average duration of chest drainage (P = 0.107). Procedure costs were comparable for both groups.CONCLUSIONS:FOREseal did not demonstrate a significant advantage over standard treatment alone.

Expression of the KLK13 and KLK14 genes was examined at the mRNA and protein levels in a cohort of 57 patients with non-small-cell lung cancer (NSCLC). The mRNA levels, assessed by real-time RT-PCR, were significantly different in malignant tissues compared to adjacent non-malignant tissues (KLK13, p=0.006; KLK14, p=0.022). KLK13 and KLK14 mRNA overexpression in tumors (1/3 of the patients) was associated with a positive nodal status in multivariate analysis (p=0.018 and p=0.069, respectively). KLK13 and KLK14 were localized in the cytoplasm of epithelial cells of normal bronchus and NSCLC, as determined by immunohistochemistry. Moreover, positive staining was significantly associated with adenocarcinoma histotype (KLK13, p=0.014) and tumor size (KLK14, p=0.048). Although the results are marginally significant, patients with high KLK13 expression at the mRNA or protein level had lower overall survival.

Most of the difficulties associated with hyperhidrosis surgery are due to unavoidable side effects and unforeseeable and unacceptable complications. Careful patient selection is important before surgery so surgeons can avoid some of these pitfalls. Patients should also be fully informed of all potential side effects and complications before surgical treatment.

L'incidence des lymphomes est augmentee chez les malades transplantes et traites par azathioprine [1, 2]. En revanche, chez les malades non transplantes et traites par azathioprine, l'incidence des lymphomes nonhodgkiniens est peu ou pas augmentee [3-5], et les cas de maladie de Hodgkin sont exceptionnels. Nous rapportons un cas de maladie de Hodgkin chez une malade traitee par azathioprine pour une hepatite chronique auto-immune.

Background. Thoracoscopic sympathectomy is now the reference treatment for severe palmar hyperhidrosis, but this is off set by the occurrence of compensatory sweating. It has been studied in this series to improve the indications and information given to patients.Methods. A retrospective review of 124 patients who were previously afflicted with bilateral thoracoscopic sympathectomy 6 years earlier was conducted. Patients were interviewed by postal questionnaire regarding the results and side effects.Results. The series consisted of 89 females (72%) and 35 males and the mean age was 28 years. The main indication was palmo-plantar hyperhidrosis (34%). The mean operating time was 36 minutes and there were no intraoperative complications. Postoperative pneumothorax occurred in 9 patients and 3 patients required a chest drain. The hospital stay was 36 hours for 87.6% of the patients. Postoperative pain occurred in 78% of the patients. Neurologic complications (Horner syndrome, radial paralysis, and dysesthesia of the arm) occurred in 3 patients and disappeared after 2-6 months. Two patients required single-side reoperation because of failure with the first intervention. Eighty-nine replies to questionnaires were received (72%). The results for hands were favorable in 98% and in 63% for axillae. Compensatory sweating occurred in 87% of the patients (serious in 36% and incapacitating in 6%). Despite this 90% of the patients were satisfied or very satisfied.Conclusions. This study confirms that thoracoscopic sympathectomy is a suitable method of treatment for severe palmar hyperhidrosis but emphasizes the need to offer the patient more informative information, especially regarding compensatory sweating which seems inescapable. (C) 2004 by The Society of Thoracic Surgeons.

Vinorelbine (Navelbine, NVB) is a new semisynthetic vinca alkaloid that is currently used in the treatment of advanced breast cancer and advanced non-small-cell lung cancer (NSCLC). In this study we investigated the tumoral and healthy pulmonary tissue concentrations of NVB in previously untreated NSCLC patients undergoing surgery. A total of 13 patients (mean age, 60 years; range, 42-70 years) were included and received NVB (20 mg/m(2)) at 1 h (mean, 1.1 h; SD, 0.2 h; n = 6 patients) and 3 h (mean, 3.0 h; SD, 0.6 h; n = 7 patients) before tumor resection. A tumoral and adjacent healthy lung-tissue specimen as well as simultaneously sampled serum were analyzed for NVB by high-performance liquid chromatography (HPLC). NVB levels were much higher in tissue than in serum (up to 300-fold). The tissue/serum ratio increased between the 1-h sampling time (range, 0.1-100) and the 3-h time point (range, 10-300). In all patients but two, NVB concentrations were lower in tumors than in healthy lung tissue. The tumor/healthy tissue ratio ranged from 0.06 to 1.3 (median, 0.09) at 1 h and from 0.18 to 1.1 (median, 0.55) at 3 h. This ratio increased between the 1-h sampling time and the 3-h time point as a consequence of increasing tumor levels (median, 50.4 ng/g at 1 h and 278 ng/g at 3 h). In four patients, concentrations could be measured in necrotic and peripheral tumor zones, showing lower values in necrotic areas. Thus, these data indicate that NVB is highly distributed in lung tissue, with the disposition rate being slower in tumor tissue than in healthy parenchyma during the first 3 h.

We reviewed a series of 194 lung opacities presumed to be bronchogenic carcinomas occurring either simultaneously with (n = 46) or metachronously to (n = 148) a head and neck cancer. The purpose of the study was to evaluate the operative mortality and morbidity and to assess with a survival analysis whether the lung lesions actually were primary carcinomas or metastases of the head and neck cancer. Operation was contraindicated in 77 patients: 36 for metastatic spread, 5 for small-cell carcinoma, and 35 for respiratory insufficiency. The remaining 118 underwent operation: lobectomy for 82, pneumonectomy for 30, wedge resection for 1, and exploratory thoracotomy for 5. The operative mortality was 5%, and the nonfatal morbidity was 22%. The survival at 5 years for patients who underwent operation for bronchogenic cancer was 19.7% (27.2% for stage I, 19% for stage II, 4.5% for stage IIIA, and 0% for stage IIIB). The survival of these patients was not significantly different with respect to the synchronous or metachronous occurrence or the histologic classification (squamous or nonsquamous). We conclude that, despite the poor survival, several of these lung lesions associated with a head and neck cancer were most likely a primary bronchogenic cancer. Surgical management is justified because of the observed postoperative mortality.

We reviewed a series of 194 lung opacities presumed to be bronchogenic carcinomas occurring either simultaneously with (n = 46) or metachronously to (n = 148) a head and neck cancer. The purpose of the study was to evaluate the operative mortality and morbidity and to assess with a survival analysis whether the lung lesions actually were primary carcinomas or metastases of the head and neck cancer. Operation was contraindicated in 77 patients: 36 for metastatic spread, 5 for small-cell carcinoma, and 35 for respiratory insufficiency. The remaining 118 underwent operation: lobectomy for 82, pneumonectomy for 30, wedge resection for 1, and exploratory thoracotomy for 5. The operative mortality was 5%, and the nonfatal morbidity was 22%. The survival at 5 years for patients who underwent operation for bronchogenic cancer was 19.7% (27.2% for stage I, 19% for stage II, 4.5% for stage IIIA, and 0% for stage IIIB). The survival of these patients was not significantly different with respect to the synchronous or metachronous occurrence or the histologic classification (squamous or non-squamous). We conclude that, despite the poor survival, several of these lung lesions associated with a head and neck cancer were most likely a primary bronchogenic cancer. Surgical management is justified because of the observed postoperative mortality.