Abstract: Pulmonary fibrosis can be caused by external agents, including certain drugs. For some time now, tumor necrosis factor antagonists such as etanercept have been used to treat certain autoimmune diseases. Fibrosis caused by medication responds to withdrawal of the drug and treatment with corticosteroids. Very rarely, fibrosis is irreversible. We present the case of a patient who developed pulmonary fibrosis after initiating treatment with etanercept. The clinical course was fulminant despite withdrawal of the drug and high doses of corticosteroids.
Abstract: OBJECTIVE: To study the results of surgical treatment of pulmonary metastases in our department. PATIENTS AND METHODS: We retrospectively studied 44 patients undergoing surgery between 1986 and 1999 for complete resection of pulmonary metastases. Primary tumors had been eradicated, no metastasis to other organs was evident, and functional respiratory capacity was adequate. The patients were assigned to different prognostic groups based on the criteria of the International Registry of Lung Metastases. RESULTS: Forty-eight operations were performed on the 44 patients (21 men and 23 women) whose mean age was 58 years (31-74 years). The most frequent type of primary tumor was epithelial (82%); other types in order of frequency were sarcoma (9%), thyroid gland (4.4%), germ cell (2.2%) and melanoma (2.2%). The mean disease-free interval was 37.7 months (0.168) and the median was 30 months. A single site of metastasis was seen in 66.7% of the cases whereas 33.3% had multiple metastases (17.9% of them bilateral). Posterolateral thoracotomy was the surgical approach in over half the cases (66.7%). We performed wedge resections in 86.6% and lobectomies in 11.1%. Perioperative mortality was 4.4%. Mean survival was 70 months, with 87% alive at one year and 29% at 10 years. For group I (resectable, no risk factors; n = 13) survival was 100% at one year and 75% at 10 years. For group II (resectable, one risk factor; n = 16) the actuarial survival was 78% at one year and 12% at 10 years. For group III (resectable, two risk factors; n = 8), survival was 87% at one year, 62% at three years, 15% at four years and 0% at five years (Log-rank chi 2 9.8 [df = 2)], p = 0.0097). CONCLUSIONS: Surgical resection of pulmonary metastasis is a treatment and diagnostic procedure associated with low mortality and good survival. Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival regardless of histological typing of the primary tumor.
Abstract: Our aim in reviewing all cases of chest wounds (CW) treated in our unit to analyze their causes, clinical characteristics and treatment. We performed a retrospective study of all CW patients admitted and/or treated by us between January 1986 and August 1997, studying causes, history, number and type of wounds, location, the association of chest and non-chest lesions, treatment, complications and length of hospital stay. The 90 CW patients treated in our unit accounted for 10.6% of all CW patients admitted during the study period. Eighty-five (94.4%) were men and five were women (5.6%) and mean age was 33.87 years. Physical attack was the most common cause of CW, accounting for 74 cases (82.2%) and stab wounds (77 cases, 85.6%) were more common than gunshot wounds (13 cases, 14.4%). Sixty-one (67.%) were deep and most were to the left hemithorax (46 cases, 51.1%). Besides damage to skin and soft tissues of the chest wall, lesions most often affected the pleura (59 cases, 65.5%) and parenchyma (27 cases, 30%). Local treatment of the wound was sufficient for 31 patients (34.4%) but 29 (32.3%) also required drainage and 30 (33.3%) required surgery. Complications developed in 8 cases (8.9%) and one patient died while in surgery. Mean duration of hospital stay was 8.64 days. CW in our practice is seen most commonly in young men and is caused by physical aggression, usually involving knives. Most wounds are stabs, usually to the left hemithorax. The prognosis for firearm wounds is poorer. One third of patients require thoracic drains and another third require chest surgery in addition to local treatment of CW and other wounds. The patient's hemodynamic status was the parameter that indicated need for surgical treatment.
Abstract: A 75-year-old woman was admitted to our hospital with persistent fever, productive cough and systemic symptoms of two months' duration. A chest film showed bilateral infiltration in the form of subpleural plaques with multiple satellite nodules in both lung fields. The biopsy specimens taken by thoracoscopy were compatible with inflammatory pulmonary pseudotumor. Lung resection was ruled out because the lesions were bilateral and corticosteroid treatment was instated. The clinical and radiologic response was excellent and the patient was asymptomatic after 30 months of low-dose corticoid therapy.
